Who is Eligible for Services?
• Individuals from birth through age 21 who are deaf-blind.
• Family members and care providers of individuals who are deaf-blind.
• Personnel from public and private schools, as well as public and private agencies, who serve persons who are deaf-blind and their families.
Very few children who qualify for the census are totally deaf or blind. Qualified individuals may have additional disabilities, such as: intellectual disabilities, motor, or medical conditions.
If you are able to circle a number under vision loss and a number under hearing loss, you may wish to refer this child to the OKDBTAP. You may check cortical vision impairment as a loss in vision.
DEGREE OF VISION LOSS - Circle one below.
1. Low Vision (visual acuity of 20/70 to 20/200)
2. Legally Blind (visual acuity of 20/200 or less or field restriction of 20 degrees)
3. Light Perception Only
4. Totally Blind
5. (# 5 code has been omitted)
6. Diagnosed Progressive Loss
7. Further Testing Needed
8. (#8 code has been omitted)
9. Documented Functional Vision Loss
Does this child have the diagnoses of Cortical Visual Impairment (CVI)?____no ___yes ____unknown
HEARING LOSS - Circle one below.
1. Mild (26-40 dB loss)
2. Moderate (41-55 dB loss)
3. Moderately Severe (56-70 dB loss)
4. Severe (71-90 dB loss)
5. Profound (91+ dB loss)
6. Diagnosed Progressive Loss
7. Further Testing Needed
8. (#8 code has been omitted)
9. Documented Functional Hearing loss
Has this student been diagnosed with Auditory Neuropathy? ______no ______yes ______unknown
Does this child have a cochlear implant? ________no ________yes __________unknown
Who
Can Request Services?
Any parent or guardian of a child with deaf-blindness, ages birth - 21 years, may request technical assistance from the project. In addition, educational personnel and service providers from Oklahoma’s SoonerStart Program, Oklahoma School Districts (LEAs) or other agency personnel serving students with deaf-blindness may also request services.
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There are NO FEES for services. ~