877-553-4332 ~ www.OklahomaParentsCenter.org ~ info@oklahomaparentscenter.org
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Name: City: Oklahoma Ethnicity: African American Asian Caucasian Hispanic Native American Other Person Type: Parent of a child with a disability Person with a disability Family member of a child with a disability Educator Professional Age of Individual with Disability: 0-5 6-8 9-16 17-22 +21 Primary Disability (Check One): ADD/ADHD Autism Emotional Disaiblity/ ED-BD Health Impairment/Med Fragile or At-Risk Hearing Impairment/Deafness Learning Disability Mental Retardation Multiple Disabilities (None Primary) Neurological Impairment Orthopedic Impairment Speech/Language Disorder Traumatic Brain Injury Visual Impairment/Blindness Suspected But Undiagnosed Developmentally Delayed Other Please choose course: Making Your Case Partners in Education Email:
