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参加人数： 名字 姓氏: 公司（如适用)： 电子邮箱: 地址: 城市: 州: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Federated States of Micronesia Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico U.S. Minor Outlying Islands Virgin Islands Armed Forces Americas Armed Forces Europe, the Middle East, an Armed Forces Pacific Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Territory Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory 邮编: - Zip Suffix 郡: 电话: 电话类型 Home Mobile Other Work 主要角色: Parent/Primary Caregiver Other Family Member Resource or DD Foster Parent (Foster Parent) Individual w/Disability CASA Community Partner Early Childhood: EI/ECSE Early Childhood: Provider/Staff Educator: General K-12 Educator: Higher Education Educator: Special K-12 Educator: Transition Services (18-21) I/DD Professional Medical/Therapy Provider Provider State Agency Staff Tribal Partner Voc Rehab Admin/Staff Other Youth with a disability (14-26) Community Partner – General DD Services - CDDP Admin/Staff State Agency - Admin/Staff 您或您的家人是否获得诸如免费或优惠午餐、SNAP（食品福利）、WIC、TANF、住房援助或郡心理健康服务等支持? Yes No Prefer Not to Answer 您的家人中是否有人使用俄勒冈州健康计划（包括 DD 服务／CHIP）？ Yes No Prefer Not to Answer