Indiana State University : Blumberg Center : Indiana Deafblind Services Project: Technical Assistance

Blumberg Center
for Interdisciplinary Studies in Special Education

Green and yellow starburst on the upper left with Indiana Deafblind Services Project in white on dark green on the right. A goldenrod line at the top lists the project links in blue - Home, Deaf & Hard of Hearing, Deafblind, Problem Solving and Project Vision

Technical Assistance

Request Form

If you would like technical assistance services for your Indiana child/student who is deafblind (has both a vision and hearing loss), please complete and return the request form to the Indiana Deafblind Services Project. Once this information is received, you will be contacted by Project Staff to follow-up on your request.

Please provide the following contact information:

First Name
Last Name
Title
Organization
Street Address
Address (cont.)
City
State
Zip Code
Work Phone
Home Phone
E-mail
Name of Your Child/Student
Relationship to the Child
What type of technical assistance are you interested in receiving?
Home Visit School Visit Case Conference Inservice Training Resource Materials Phone Call Email
Other (specify)
What are the best times to contact you? AM/PM

Topics of Interest

(Please put a check next to the topic(s) of interest)

1. Academic Standards

2. Assessment

3. Behavior

4. Causes of Deafblindness

5. Communication

6. Early Intervention

7. Identification of Students who are Deafblind

8. IEP Development

9. Instructional Strategies

10. Person Centered Planning

11. Recreation/Leisure Activities

12. Transition

13. Other Topic

(Specify the topic:)

You may submit this form now over the Internet by clicking the "submit" button or complete this form, print it and return to:

Indiana Deafblind Services Project
Blumberg Center
College of Education, Room 502
Indiana State University
Terre Haute, IN 47809
Fax: 812-237-8089.

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