OCECD On-Demand Registration

1

Your Email* This field is required.

example@example.com

2

Your Name* This field is required.

First Name

Last Name

3

What County in Ohio do you live in?* This field is required.

4

What best describes where you live?* This field is required.

Rural

Urban

Suburban

5

What best describes you?* This field is required.

6

Educator* This field is required.Check all that apply

Special Education Teacher

Regular Education Teacher

School Administrator

N/A

7

Parent* This field is required.(Check all that apply)

Parent/Foster Parent of a child with a disability

Person with a disability

Family Member of a child with a disability

Consumer/Student/University Student

N/A

8

Professional* This field is required.(Check all that apply)

Medical/Health

Other Service Provider

N/A

9

My Child is Transition Age (14 or older in Ohio)* This field is required.

YESNO

10

If you’re a parent of a child with a disability:Please provide the child's age and child's identified disability.

Child's Age

Child's Identified Disability

Child 2's Age

Child 2's identified Disability

11

Have you attended an OCECD workshop before?* This field is required.

Yes

No

12

Preferred Language* This field is required.

13

Do you participate in any cross disability coalitions, policy boards, advisory boards, governing bodies or serve in any leadership positions?

YESNO

14

Do you currently participate in any advocacy activities in the disability space?

YESNO

15

Unique ID

16