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T/TAC Email List Online Request Form

If you would like to receive T/TAC W&M announcements via email, please complete the information below.
Please note:  Only persons residing in Regions 2 and 3 will be eligible.

Title 

First Name

Last Name 

School/Agency Name

School Division

E-mail Address (Required)

School Address

City

State/Province

Zip/Postal Code

Country 

School phone

School fax 

Choose one of the following to describe your position:

Disability descriptions of children served (please check all that apply):
ADD/ADHD
Autism
Deaf Blind
Deafness
Developmental Delays
Severe Emotional Disturbance
Hearing Impairment
Learning Disability
Mental Retardation
Multiple Disabilities
Orthopedic Impairment
Speech/Language Impairment
Traumatic Brain Injury
Visual Impairment
Other Health Impairment
Severe Disability

Choose which of the following describe your program affiliation:
Early Childhood Special Education
Early Intervention
General Education
School Age Special Education
Other
Adult Education/Family Literacy
Even Start
Head Start
Homeless
Migrant Education
Occupational Child Care
Preschool Initiative
Title 1