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2. Teacher first & last name (preferred name):
4. Pronouns
5. Contact info:
7. School name:
8. Total # of students:
10. For this section:

    Please list the total number of people to whom the disability applies to. Add notes, comments, or additional disabilities.

12. 1. Do you have any students with a mobility or physical disability in your class?

    1. Yes
    2. No
14. If yes, please include the number of students and any details on how we can best accommodate these students.
16. 2. Do you have any students that are deaf or hard of hearing?

    1. Yes
    2. No
18. If yes, please include the number of students and any details on how we can best accommodate these students.
20. 3. Do you have any students that are blind or low vision?

    1. Yes
    2. No
22. If yes, please include the number of students and any details on how we can best accommodate these students.
24. 4. Other accommodations needed:
26. Thank you! If you have any questions, please connect with Megan at hogfeldtm@ci.superior.wi.us.
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28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

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