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Info Request

 

 

Please complete the following form to receive more information about the RTC in Special Education and Elementary or Secondary Education.

Last Name:        First Name:   

Phone Number:     

Email Address:     

Gender:    Male     Female

Ethnicity:

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Black/African American

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Native American (Indian, Eskimo, Aleut)

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Other:

 

Did you attend an information session?   Yes    No

 

How did you hear about the RTC in Special Education program?

 

 

What was the specific source of your information (i.e. name of university, name of radio station or newspaper)?