The deadline for
submission of applications/nominations is December 17, 2003
Mothers and Fathers
of children who are deaf, hard of hearing or deafblind are encouraged to apply!
Complete the application by providing the information requested below. Be sure
to include your completed reference form (attached) and send it in with this
If you are interested in being considered for a Parent Guide position, but need
special accommodations to apply, contact us. Questions can be directed to: Marcy
Dropkin at 262-787-9540 v/tty or email@example.com
or Elizabeth Seeliger at (608) 267-9191 or
How did you learn
about the Guide-By-Your-Side Program?
Email Address (if available):
County of Residence:
Local School District:
Phone Numbers: Day--
Please summarize your experience(s) in raising a child(ren) who is/are deaf, hard of hearing or deafblind (including age(s), age of and experience with the identification process, Birth to 3 and/or educational services, technological and communication mode choices, etc.):
Why are you interested in a position with the Wisconsin Guide-By-Your-Side Program?
Why are you qualified for this position?
Describe a time that you provided information to someone in an unbiased way:
Describe strategies that you would use to find out about resources in your county, region, or state:
We plan to schedule regional interviews for qualified applicants. Interviews are scheduled for the first week in January and attendance at one interview session will be mandatory. Circle the best time to meet with you:
____ Check here if you need special accommodations for the interview.
E-mail: firstname.lastname@example.org or email@example.com
Fax: 1-262-787-9501 (attn: M. Dropkin)
One West Wilson St
PO Box 2659
Madison, WI 53701-2659