Directory Consent Form
Thank you for agreeing to participate in the directory. Please fill out this
consent form as completely as possible and return by February 27, 2004. Because
this involves your signature, we need a "hard" copy of this so please mail it
or fax it back to us.
Fax (if available):
Please indicate your consent for the following:
- _____ I give my
permission to include the information provided on the Biographical Form in
the Parent Consultant Directory, a project funded by the Wisconsin Department
of Public Instruction's State Improvement Grant and the Waisman Center University
Center for Excellence in Developmental Disabilities for the years 2004-2007.
- _____ I would like
to be included in the Waisman Center's Family Action Network mailing list
to receive valuable information for families with children with special needs.
Please return this to:
c/o Mary Shaw
1500 Highland Avenue
Madison, WI 53705-2280
Or Fax it to us at: 608-265-3441 attention: Mary Shaw