Montana School for the Deaf & the Blind

Who is completing this form?

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Full Name of School Representative

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Title/Role at Current School

School Name

School Email Address

School Phone Number

Full Name of Provider

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Practice or Office Name

Provider Email Address

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Full Name of Support Representative

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Organization Name

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Full Name of Person Completing This Form

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Title/Role (if applicable)

Organization (if applicable)

Email Address

Phone Number

Is the parent aware you are completing this inquiry?

Yes No

You need to alert the parent before proceeding forward.

Does this child have a current audiogram or doctor vision report?

Yes No

Please fax a copy to (406) 771-6164 ATTN: Outreach Office

Please request the audiogram or doctor's vision report.

Date

mm/dd/yyyy

Students can attend the Educational Program on MSDB's campus in Great Falls for a number of reasons. Attendance in the Campus Education Program can be as a day student for those residing near Great Falls or as a residential student for those who live farther away. Students age 18-months through age 21 are eligible to attend the campus program.

MSDB Outreach Services may assist in determining the needs of children and students, from birth through age 21, identified with or suspected of meeting the IDEA qualifying disability category of deafness, hearing impairment, visual impairment, or deafblindness.

Please have parent's/guardian's permission first before submitting an inquiry. Also be ready to provide our school with a copy of the student's or child's audiogram or doctor vision report.

We are excited that you are exploring MSDB as a possible placement for your child. Whether this would be a full-time student, outreach student, and/or a summer program attendee, please fill out the inquiry form and one of our team members will be in touch with you shortly.

How can we help you today?

I would like to:

Inquire about Campus Services

How would you like us to reach out?

What questions about campus services do you currently have?

Inquire about Outreach Services

How would you like us to reach out?

What questions about outreach services do you currently have?

Inquire about Special Events

How would you like us to reach out?

What questions about MSDB special events do you currently have?

Campus Enrichment Days
Provide socialization and learning opportunities for elementary through high school students who are deaf or hard of hearing, blind or visually impaired, or DeafBlind. The weekends encourage students to interact with their peers and build confidence through age-appropriate activities designed to foster independence. Students participate in classes covering core curricula and specialized skills such as Braille, low vision technology, life skills, social skills, and career development. Field trips focus on developing orientation, mobility, social skills, and self-esteem. Sports like Goalball and Showdown provide opportunities for competitive play and team-building. Activities also include technology, mobility, independent living, and hands-on projects like art, making the events both educational and social. The program takes place twice a year and serves students from across Montana.

Deaf and Hard of Hearing Family Learning Weekend
The Learning Weekend for Families of Deaf and Hard of Hearing Children is a creative program that provides opportunities for families to learn about deafness, share their experiences with other families, and learn how to communicate more fully with their child in a warm, caring atmosphere.

Visually Impaired Family Learning Weekend
The Learning Weekend for Families of Blind and Visually Impaired Children is designed to be both informative and empowering for families. The weekend provides opportunities for families to learn about blindness and visual impairment, share their experiences with other families, and communicate with one another in a warm and caring atmosphere.

Deaf and Hard of Hearing Summer Camp
Deaf Camp is for deaf and hard of hearing students between the ages of 9-14 (7 and 8 year-olds will be considered on a case-by-case basis). This week-long program offers a great opportunity for deaf and hard of hearing children who attend schools in their home districts to be with other children who communicate like they do. This is a powerful antidote to the isolation deaf and hard of hearing students experience. It also gives them an opportunity to further develop their language skills.

Visually Impaired Summer Camp / Camp-a-Bilities
The Visually Impaired Summer Skills Program is open to blind and visually impaired students, ages 9-16. Participants learn a wide range of living skills, which builds self confidence. They cook their meals, do laundry, learn to sew, plan menus, shop, and use public transportation. They learn new orientation and mobility skills, which can dramatically increase their independence. They learn new communication skills, including Braille, JAWS - a computer program that reads information on the screen aloud - as well as other assistive technology. They play pool, and bowl, and overcome obstacles to living as other students do, all the while enjoying the company of other students who are blind or visually impaired, which greatly increases their sense of connection.

Transition Camp
Description

Braille Challenge
Description

I am interested in the following (select all):

Inquire about Student Group Activities

How would you like us to reach out?

Cane Club - a service organization of students who are blind or visually impaired
Expressions of Silence (EOS) - a signing and dancing performing group
Flying Hooves Club - a performing group using ASL and De'VIA art
Gallaudet University Academic Bowl - an academic competition with other schools for the deaf
Moving Mustangs - a club focused on exercise
NAD - a Chapter for deaf and hard of hearing students 7-12 grade learning about leadership
Visually Impaired Performers - a singing group of students who are blind or visually impaired

How would you like us to reach out?

What is the purpose of the tour? (student/community/etc)

About the Student

Name

First

Middle

Last

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Preferred Name

Gender

Date of Birth

mm/dd/yyyy

Identify Student's Main Disability Criteria on IEP/IFSP

Please select the school year for which you are submitting this inquiry. Choose the year your child or student may enroll at MSDB, receive Outreach consultative supports, or participate in an MSDB program or special event.

School Year of Interest

Please select your student’s current age or grade level at the time you complete this form.

MSDB provides Outreach Consultative Supports for children from birth through age 21 and on-campus programs for students ages 18 months through 12th grade (high school seniors).

Please note: For on-campus enrollment, the selected grade level should reflect the grade your student will enter after completing the 10-Day Observation and officially accepting a program. For special events, such as Campus Enrichment Days or Summer Camps, and extracurricular activities, select the grade your student will be in at the time of the event. Eligibility for special events and extracurricular activities is determined on a case-by-case basis.

Age or Grade of Individual Being Referred

Please confirm your student's age:

County of Residence

If your school is not listed, please select "Other" located at the bottom of the list.

Current School

Current School Name if You Select Other Above

About the Parent/Guardian

Name

Title

First

Middle

Last

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Preferred Name

Relationship to Student

Cell Phone (xxx-xxx-xxxx)

Type

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Home Phone (xxx-xxx-xxxx)

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Email

Mailing Address

Second Parent or Guardian

Name

Title

First

Middle

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Preferred Name

Relationship to Student

Cell Phone (xxx-xxx-xxxx)

Type

Number

Email

Mailing Address

Who does the student live with?

Other, please specify:

Is there a court-ordered parenting plan or decree that designates legal custody or residential rights?

Yes No

Please note that you may be asked at a later point to provide a certified copy of applicable custody or court documentation if the student qualifies for supports.

We value open communication with both parents. Please confirm that the other parent/guardian is aware of this enrollment application.

Yes No

Thanks for reaching out! Out of curiosity...

How did you hear about Montana School for the Deaf & the Blind?

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