Deaf Education Network (DEN)
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Language Specialist Service Request
School/District/Cooperative Name
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Federal Tax ID Number
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Contract/Invoice Address
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Line 1
Line 2
City
State
Zip Code
Country
LEA Director Name
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First
Last
Phone Number
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Email
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Contract Signatory Name
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First
Last
Phone Number
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Email
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Language Specialist Scope of Services
Services
Provide American Sign Language -or- Listening and Spoken Language direct instruction, consultation, resources and/or support to the student and/or school staff.
Provide appropriate academic and social support to children who are deaf and hard of hearing.
Assist families of children who are deaf and hard of hearing to access resources in a timely manner.
Attend case conferences as requested.
Training
Educate professionals who work with students who are deaf and hard of hearing.
Educate parents of students who are deaf and hard of hearing.
Communication
Collaborate with school staff.
Communicate with student and family.
Report on student progress.
Provide Summary of Service documentation to specified recipients after services have been rendered.
Additional Language Specialist Services
The Center for Deaf and Hard of Hearing Education (CDHHE) can additionally provide the following services. Please check the services and responsibilities that you expect from the Language Specialist:
Meeting style
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In-person
Virtually/Remotely
Location
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school
home
community
other
Provides DHH student(s) with support regarding:
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language/literacy model (please complete Indiana CDHHE Communication Plan)
social/emotional
self-identify
Deaf Culture
self-advocacy
ASL evaluation
using CART services
using an interpreter
using a notetaker
Provides DHH student's family with support regarding:
*
language
social/emotional
Deaf Culture
community experiences
transition
self-advocacy
ASL instruction
Provides school staff with support (in-service/training/professional development regarding:
*
language
hearing loss in general
understanding DHH student social/emotional needs
Deaf Culture
provision of community experiences
Deaf/Hard of Hearing transition
provision of self-advocacy
Deaf/Hard of Hearing access
using an interpreter
IEP accommodation recommendation
extra-curricular club extablishment
in-service training and school-age experiences
ASL storytelling
other specific student needs
Name of person filling out the form
*
First
Last
Date
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Submit