OUTREACH PROGRAMS MAILING LIST APPLICATION

We invite you to be on our Outreach Program mailing list.

The Outreach Program at TSBVI regularly sponsors conferences and workshops on subjects related to parenting or providing services to young people with visual impairments, deafblindness, and other disabilities.

Outreach also publishes, with the Texas Department of Assistive and Rehabilitative Services, SenseAbilities, a quarterly newsletter with timely information on many topics, including articles by family members, strategies for working with young people who are visually impaired or multiply disabled, information about agencies and programs, medical and health information, and classified ads and announcements.

To receive announcements of upcoming workshops and the quarterly newsletter, SenseAbilities, fill out this form in its entirety and return it to TSBVI Outreach.

Is this a new listing change of address ?

First Name:
Last Name:
Agency name:
(optional, but must be filled in if no individual is designated to receive this information)

Year round mailing address: (street)
(street2)
(city)
(state)
(country if outside of US)
(zip code)

Is this address at work home ?

Optional

PHONE NUMBERS
Work Phone:
Home Phone:
Fax:

Email address:
Reenter Email address:

School District:

EDUCATION SERVICE CENTER REGION (if known)

Title (must check at least one, can check more than one)

Family member (relationship to child)
Community Member
Consumer
Parent support staff (i.e. PATH, Pilot Parent, etc.)

AI Teacher	AT specialist	Deafblind Teacher
ECI interventionist	ESC consultant	General education elementary
General education secondary	Headstart teacher	Inclusion teacher
PPCD teacher	RDSPD parent advisor	Resource room teacher
Self-contained special education teacher	Technology teacher	University staff
VI teacher

Audiologist	COMS	Counselor
Diagnostician	Medical doctor	Nurse
OT	Psychologist	PT
Social worker	Speech/Language pathologist

Braillist

Interpreter

Intervenor

Paraprofessional

Director of special education	Principal	RDSPD director
Supervisor	TEA Specialist

BVICP	Deafblind specialist	Home support provider
Rehab counselor	Rehab teacher	Respite provider
State Program administrator	Transition Specialist

Advisory board member	Legislator
Outreach specialists	School board member

FORMAT IN WHICH YOU WOULD LIKE TO RECEIVE SEE/HEAR

(please check only one):

print (English)	large print (English)	braille (English)
audio (English)	web (English) (note: if you choose this, you must go to the See-Hear Newsletters Index and register for Mind-it so you will be notified of new issues)	disk (English)
print (Spanish)	web (Spanish)	disk (Spanish)

or you can print this form and mail it to--

Texas School for the Blind and Visually Impaired
Outreach Department
1100 West 45th Street
Austin, Texas 78756-3494

Agency Contact Information | Texas State Homepage | Texas State Wide Search

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Last Revision: July 10, 2006