Young Exceptional Children Interest Form

Young Exceptional Children Interest Form
Honorific Identification
i.e. Ms., Dr., Mx., Professor, etc
Name

First NameLast Name
Pronouns
Email
example@example.com
Title
Institutional Affiliation/Workplace (if any)

Editorial Experience
Upload CV, resume or statement of lived experience

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Describe how the DEC Racial Equity POV will impact your role at YEC. (100-200 words)

0/200
Role Interested in with YEC

Other - Please describe

Primary Areas of Expertise

- Assessment
- Assistive Technology
- At risk for school readiness
- Autism spectrum disorders
- Behavior challenges and disorders
- Cerebral palsy
- Childcare
- Classroom based services
- Cognitive development
- Cultural and Linguistic
- Diversity Curricula
- Down Syndrome
- Fetal Alcohol Syndrome

- Genetic Disorders
- Hearing Loss
- Speech and Language Delays
- Intellectual disabilities
- Language and communication
- Literacy
- Motor development
- Neurological impairments
- Play
- Self help development
- Social development
- Visual impairments

Please rank your top three areas of expertise. (You are not limited to the options above.)
Primary Age Level Focus

Demographics

If you prefer not to complete any of the demographic related fields below, please enter "Prefer Not to Say".
Gender
Race/Ethnicity
Primary Language
Do you identify as having a disability?
Are you the primary caregiver or family member of a person with a disability?
Sexual Orientation
Geography
Area of the Country
Should be Empty: