2026 Project Independence - Registration
Full Name/ Nombre
E-mail
*
Phone Number/Número de Teléfono
Address/ Domicilio
City/ Ciudad
State/ Estado
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces Africa
Armed Forces Americas (except Canada)
Armed Forces Canada
Armed Forces Europe
Armed Forces Middle East
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
District of Columbia
Federated States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code/ Código Postal
County/ Condado
Adams
Arapahoe
Boulder
Broomfield
Denver
Douglas
Jeffco
Other
Please indicate whether you are one of the following / Por favor, indique si usted es uno de los siguientes:
Parent or Guardian / Padre o tutor
Therapist/ Terapeuta
Advocate or Professional /Abogado o Profesional
Student/ Estudiante
Caregiver
Other
Child's Name/ Nombre del Niño
What is your child/children's age(s)?/ ¿Cuál es la edad de su(s) hijo(s)?
What is your child's disability?/¿Cuál es la discapacidad de su hijo/a?
ADD-ADHD
Autism Spectrum Disorder / Autismo
Deaf-Blindness / Sordo ciego
Developmental Delay / Retraso en el desarrollo
Emotional Disturbance / Trastorno Emocional
Gifted / Dotado
Hearing Impairment (include Deafness) / Impedimento Auditivo
Intellectual Disability / Discapacidad intelectual
Orthopedic Impairment (Physical) / Impedimento ortopédico
Other Health Impairment / Otro deterioro de la salud
Specific Learning Disability / Discapacidad específica de aprendizaje
Speech/Language Impairment / Impedimento del habla o el lenguaje
Traumtic Brain Injury/ Lesión Cerebral Traumática
Visual Impairment (include blindness) / Impedimento Visual
Suspected/Undiagnosed / No diagnosticado
No IDEA Disability/ Sin discapacidad de IDEA
I do not have a child with a disability. / No tengo un hijo con discapacidad
Please describe your race/ethnicity./¿Por Favor de describir su raza/orgen étnico?
Hispanic/Latino
Declined
No
Please describe your race/ethnicity./¿Por Favor de describir su raza/orgen étnico?
Black/African American
White/ Caucasian
Asian
Native Hawaiian/ Pacific Islander
Indigenous American/ Alaska Native
Undisclosed
Two or more races
Will you need Interpretation Services?/¿Necesitará servicios de interpretación?
Yes/ Si
No
If yes, what language do you need interpretation services in?/ En caso afirmativo, ¿en qué idioma necesita los servicios de interpretación?
How did you hear about Show and Tell? / ¿Cómo se enteró Show and Tell?
Do you want to sign-up for our e-newsletter?/ ¿Quieres suscribirte a nuestra newsletter?
Yes
No
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