Discovery Retreat Nomination Winter/Spring 2021

Discovery Retreat Nomination Form

Important: This form should be filled out by the staff person who best knows the nominated student.
Please Note: Unlike past Nomination Requests, this Nomination process includes 2 retreats:
1. March 5-7, 2021, for 11th and 12th graders
2. April 23-25, 2021, for 9th and 10th graders
Please nominate students from each of these grades that you feel will benefit from attending Discovery Retreat as well as be able to actively participate in the academic aspects of the programming. After looking through the nominations, the DR Staff will confirm which students have been accepted to their grade-appropriate retreat.

Thank you!

Student Communication Needs and Leadership Potential
Preferred Communication Modes (select one or more) *

Auditory/Oral ASL Signed English Other
If 'Other' please explain: *

For Group Communication, student uses (must answer each):: *

Always

Often

Sometimes

Rarely

Never

Hearing Aids

Cochlear Implants

Assistive Listening Equipment

Sign Language Interpreter

Captioning (CART or other)

Leadership Potential
How does this student rank compared to all other hard of hearing and deaf students you have worked with in the past in terms of future leadership potential? *

Top 10% Top 25% Top 50% Not in Top 50%
List two (brief) reasons why you think this student is a potential future leader and should be selected for this retreat: *
Reason 1
*
Reason 2

Discovery Retreat Nomination Form