Graphic: Helen Keller National Center for Deaf-Blind Youths and Adults

NTT SEMINAR APPLICATION

 

When you have completed the form below, please click the "SUBMIT" button below.

 

For more information about the seminar please contact Doris Markham directly at 516-944-8900 Ext. 233. 

 

Applications MUST be received 3 weeks in advance of the seminar you wish to attend

 

Payment is NOT required with this application.   

                                    

APPLICATION FOR PROFESSIONAL TRAINING SEMINARS

Please provide the following information:

Name of Seminar you wish to attend: (required)

First Name: (required)

Last Name: (required)
Employer: (required)
Mailing Address: (required)
City: (required)
State/Province: (required)
Zip/Postal Code: (required)
Primary Phone with Area Code: (required)     
Secondary Phone with Area Code:  
E-mail: (required)
EMPLOYMENT INFORMATION

Employment information:

(Start with your present position)

 
ORGANIZATION POSITION FROM TO
Supervisor's name:
Supervisor's contact #:

LODGING/MEALS
Will you require a room in the HKNC residence for this seminar? (response required) Yes No
Gender: (required) Male Female
Do you have any dietary restrictions? (required) Yes No      If yes, describe:
Do you have any additional needs? (required) Yes No      If yes, describe:
Arrival date and  approximate time to HKNC:    
Departure date and approximate time from HKNC:    
INFO/ACCESSIBILITY
Please indicate preference of info format: (required)  

Other  

Assistive Listening Devices available upon request. Please indicate preference:

FM    Infrared     

Other  
 

Preferred spoken language (if not English):  

Are interpreting services required?

(required)

Yes No
If yes, please indicate communication preference:
Other, please explain:

 

If you request interpreting services, you must notify us 28 days prior to the seminar or we may not be able to secure appropriate interpreters.

Cancellation policy: A minimum of 3 business days cancellation notice prior to start of seminar or 1 day interpreter fee will be passed on to you.

Are you familiar with any means of manual communication? Please check the appropriate boxes: (required)  

Sign language:

One-hand manual alphabet:

Experience with tactile sign language:

Expectation for this seminar: Please consider your present or envisioned role in providing services to deaf-blind youths and adults.  

 

 
Cancellation Policy: Please notify us 2 weeks prior to start of seminar.

 

Copyright 2014 Helen Keller National Center. All rights reserved.

Updates: last modified 05/23/2014