Auto defensoría de los niños sordos – APNI Inc de Puerto Rico

Name *

Surnames *

Telephone numbers

Email *

Town *

How is your living area considered: *UrbanRural

Which category best describes you? You can check more than one.

Mother/father/caregiver of a child with hearing loss/deafService provider of a child with hearing loss/deafPCANU Staff, Universal Neonatal Hearing Screening ProgramAPNI StaffStudentOther

Other:

Please tell us in which town you live and in which town you work.

If you answered "Other" in the previous question, specify your educational level:

Please write down the name of the school of the child with hearing loss. If you are a professional, write down your workplace:

Other:

My ethnicity is: *Hispanic or LatinaNot Hispanic or LatinoI don't want to disclose it

Other:

The child has hearing loss and another condition *

Reasonable accommodation for the adult:

Diet restrictions

Which category best describes you? You can check more than one.

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