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Type of Phone Number? (required)
mobilehomeoffice

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Are you fluent in English? (required)
yesno

If no, what is your preferred language?

Would you like a translator? (required)
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Are You: (required)
I am a parentI am a professional (Please give title and agency information below)I am bothOther (please specify below)

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Child's Ethnicity:
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How did you hear about our program? Check all that apply.
Community AgencyCounty Resource ManualDoctorFamily member/friendNewspaperOtherOther WebsiteOther Agency EmailOther ParentOther Parent CenterOther WebsitePrevious SUPAC ContactSchool DistrictSearch EngineSEPSTA/PTASU WebsiteSUPAC EmailSUPAC FacebookSUPAC LiteratureSUPAC PinterestSUPAC Training/WorkshopSUPAC Twitter

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