Basic Information
Contact information
Request Information
Please list the name and title of persons who plan to be present for the on-site consultation (max 6 people):
Information About the Child/Student
Level of hearing loss (without hearing aids or cochlear implant):
*Note: A child can be registered with OCDBE and receive services for one year if further testing is needed to verify and determine the nature of the child's hearing loss.
Level of vision loss (best eye, with correction):
*Note: A child can be registered with OCDBE and receive services for one year if further testing is needed to verify and determine the nature of the child's vision loss.
Communication modes used by the child/student to express him/herself (please check all that apply):
Communication modes used by individuals to communicate to the child/student (please check all that apply):
Orientation & Mobility used by the child/student (check all that apply):
Self-Help Skills:

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