KidsWorld Deaf Net Registration Form


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Registration Form

Please fill out the information below and click on the Submit button (at the bottom of this page). You can use the User Name of your capitalized first and last name (ex.: John Smith) and Password of your last name (ex.: Smith) within two business days. You can change your password at any time at: http://academic.gallaudet.edu/portal.nsf/usersettings.

Use your User Name and Password to access the Discussion Forum of KidsWorld Deaf Net (KWDN). Registration is not necessary to use the Virtual Library.

Do you already have a User Name and Password? Click here to skip this page and enter the Discussion Forum. If you've forgotten your User Name and Password, click here to e-mail: Jennifer.Hinger@Gallaudet.edu

Please note: *items are required.

*First Name:
*Last Name:
*E-mail address:	Please check: Is your e-mail address correct?
Your address:
City:
State:	ZIP code:
Country:
Phone:
Fax:
School/Agency:
Job title (if with school or agency):
School District:
*Please choose the region where you live/work:

*Please select the type of place you live from the pulldown menu:

Type of Organization (if applicable)

School for the Deaf

		Public		Private
		Residential		Day

Public School

Regular
Resource
Self-Contained

Private School

Regular
Resource
Self-Contained
Residental
Day

Post Secondary
Organization/Agency
Hospital/Homebound
Other
Describe:
Not Specified

*Please tell us who you are:
(and if you are a service provider, the number of each of the following that you serve)

For example, if you are a college student and using KWDN just for yourself, put "1" in the "Student" box. If you are a teacher and will use the KWDN information for your class of 25 deaf and hard of hearing students, put "1" in the "Teacher" box, "25" in the "Student" box, and "25" in the "Number of deaf/hard of hearing served..." box.

Teacher:
Support Personnel:
Residence Personnel:
Administrator:
Parent:
Student:
General Public:

Total number of people served in your organization:
Number of deaf/hard of hearing served in your organization:

Sign up for the Clerc Center's Mailing List
(this includes free copies
of the Odyssey magazine)
Sign up for the Clerc Center's E-Newsletter

Thank you!

Please e-mail Jennifer Hinger if you receive an error message when you click Submit. Sorry for the inconvenience!

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