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Need Assistance?

For assistance submitting data please reach out to your local Regional Director.


Instructions:

Please fill out the form to submit data related to SB1348 legislation. The form will time out at 2 hours for security and performance reasons. If you need longer than 2 hours to complete the form submit it before 2 hours and then follow the link in the confirmation email you recieve to continue entering your data.

ProgramYearSemesterGroupCohortClinical Training SiteLicense# or EIN# of Students at SiteAmerican Sign LanguageArabicChineseFarsiRussianSpanishTagalogOther# Other LanguagesAmount¹ 

¹ Did the clinical site receive donation, money, compensation, or exchange of consideration was offered or provided to the business, nonprofit, or other organization, clinic, hospital, or other location where the student was placed? If yes, enter amount.