Intake form

Name *

Email address *

What is your relationship to the student?

What is the age of the student?

What type of visual impairment does the student have?

Please select at least one option.

Blindness

Low Vision

Color Blindness

Cortical Visual Impairment

What specific topics are you interested in learning about?

Please select at least one option.

Teaching Strategies

Resources for Parents

Assistive Technology

Classroom Accommodations

Legal Rights and Advocacy

How did you hear about us?

What is your preferred method of contact?

Please select at least one option.

Phone

Email

In-Person

Video Conference

Please provide any additional comments or questions.

Additional questions or comments

Ms. Kathy's Kids