Get Technical Assistance Request Form - Vcu

Filling out the Technical Assistance Request Form is an essential step in obtaining support for children and young adults with deaf-blindness. This guide aims to provide clear and comprehensive instructions to help users complete the form accurately and efficiently.

Follow the steps to successfully complete the form online.

1. Click ‘Get Form’ button to obtain the Technical Assistance Request Form and open it in your preferred editor.
2. Enter the child's date of birth clearly in the designated field. This information helps identify the child’s specific needs.
3. Provide the child's full name in the appropriate section, ensuring accuracy for proper record-keeping.
4. Select the county or city where the child resides from the dropdown menu or fill in if necessary.
5. Indicate the school the child currently attends by filling in the relevant field.
6. Answer whether the child is currently on the Deaf-Blind Census by selecting 'Yes', 'Not Sure', or 'No'.
7. Provide your full name in the field designated for the person completing the form.
8. Fill in the agency or school name as applicable.
9. Enter your telephone number, noting the best time to contact you.
10. Optional: Include your email address for additional contact options.
11. Select your preferred method of contact: E-mail or Phone.
12. Indicate if the parent is aware of the referral/request by selecting 'Yes', 'No', or 'Either'.
13. Provide the parent/guardian's full name and telephone number for follow-up.
14. If applicable, include the administrator's name along with a checkbox confirming their awareness of the referral/request.
15. Fill in the school/program phone number and address accurately to ensure proper communication.
16. Provide detailed information about the child’s diagnoses or causes of hearing and vision loss in the respective fields.
17. Describe the hearing loss in the summary section, ensuring clarity and brevity.
18. Provide a brief description of the vision loss to help assess the child’s needs.
19. In the additional information section, briefly describe your primary concern regarding the child's needs.
20. Describe the type of help you are requesting such as training, home visits, or school visits.
21. Share any additional comments or information that the project should consider in the final comments section.
22. Once all fields are completed, save your changes, and either download, print, or share the form as necessary.

Get started on your Technical Assistance Request Form online today to ensure timely support for your needs.