DHH Book Club

Online learning programs are for students who qualify for APSEA services. Registration must be completed by their APSEA Education Support Teacher (EST).

Education Support Teacher Name:

First NameLast Name

Education Support Teacher Email Address:

example@example.com

Form Access
The email address entered ({est74}) is not on the approved user list for this form. Please verify the address entered or contact your supervisor if you require access.

Approved email address. You may complete and submit this form.

Student Name:

First NameLast Name

Grade:

If Other, please specify grade:

City/Town:

Province:

Communication Mode:

What is the learner's proficiency level in their preferred communication method?

Does the learner have any particular social or emotional considerations that should be taken into account when forming groups?

Please provide any additional information that may be helpful for grouping learner effectively.

School District/Regional Centre for Education

School Name:

School Team Contact Name:

School Team Email Address:

example@example.com

School Team Member Role:

If Other, please specify:

Is the above school contact facilitating participation in this virtual program?

If no, please identify who is responsible for ensuring the learner is adequately set up to participate in this program?

Full Name:

Email Address:

example@example.com

How did you hear about this program?

If Other for how you found out about this program, please specify

A valid approved EST email address is required before this form can be submitted.

DHH Book Club

Student Information

School Information

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