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Communication Contest Registration
Registration Deadline: April 5, 2019
Speeches Due: April 18, 2019
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* Indicates required question
Student's Name
*
Your answer
Gender
*
Female
Male
Age
*
Your answer
Grade
*
7th (exhibition only)
8th (exhibition only)
9th (exhibition only)
10th
11th
12th
Preferred Mode of Communication
*
Oral
Sign Language
Total Communication
Food Allergies or Restrictions
Your answer
Accommodations Needed
Your answer
School District
*
Your answer
Deaf Educator's Name
*
Your answer
Parent/Guardian Name(s)
*
Your answer
Address (including city and zip)
*
Your answer
Parent/Guardian Email Address
*
Your answer
Best Contact Phone Number and Name
*
Your answer
Alternate Contact Phone Number and Name
*
Your answer
Do you need to update your child's 2017-2018 Nebraska Regional Program health/permission forms? (i.e. phone numbers, addresses, emergency contact, medicine, etc)
*
Yes
No
I have not completed the forms for this school year
Notes for the Nebraska Regional Program Staff (i.e. late arrival, early departure, someone picking up your child other than parent, etc)
Your answer
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