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*

Ad HocEditorial BoardAssociate Editor
Upload CV, resume or statement of lived experience*

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

0/200
Role Interested in with YEC*

Editorial BoardAssociate EditorAd Hoc/Guest ReviewerGuest EditorOther - 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*

Young ChildrenPrenatalBirth through TwoThree through FiveSix through Eight

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?*

YesNoPrefer Not to Say
Are you the primary caregiver or family member of a person with a disability?*

YesNoPrefer Not to Say
Sexual Orientation*
Geography*
Area of the Country*
Should be Empty: