Juice Box Conversations (School Staff)

Juice Box Conversations

Our Lived Experience (DHH)
Full Name:*

First NameLast Name
City/Town:*
Province:*
Email Address:*
example@example.com
Would you like to receive notifications about new programs and opportunities directly from us? Your information will not be shared.

Yes, add my email address to your mailing list.
Information About You
Your Role:
If Other, please specify:*
Name of associated learner who qualifies for APSEA supports and services:*

First NameLast Name
Why do we ask for learners’ names?
Our staff are dedicated to providing a responsive and supportive learning experience. We work closely with families and educators across Atlantic Canada to tailor our programs as closely as possible to each learner's unique needs and often see these learners in our programs. By collaborating, we can enhance the transfer of skills between programs while upholding the highest standards of privacy and confidentiality.
Name of associated EST-DHH:
Information collected regarding learners and their associated support team is done so to ensure APSEA provides support and services to meet the needs of the population we serve.
By checking this box, I am declaring that I am a school-based staff member in New Brunswick, Prince Edward Island, Nova Scotia, or Newfoundland/Labrador.*

Yes, School-based Staff Member in New Brunswick, Prince Edward Island, Nova Scotia, or Newfoundland/Labrador.
By checking this box, I am declaring that a learner at my school is Deaf or Hard of Hearing and qualifies for APSEA supports and services.*

Yes, Deaf or Hard of Hearing Learner
School Information
School District/Regional Centre for Education*
School Name:*
Grade Level:*
Date and Time
Please specify a date and time that works for your class:
An APSEA staff member will follow up to confirm a date/time and finalize details.
Feedback
How did you hear about this program?*
If Other for how you found out about this program, please specify
Should be Empty:

Juice Box Conversations

Information About You

School Information

Date and Time

Feedback