Help the Florida & Virgin Islands (FAVI) Deaf-Blind Collaborative to help children and youth with deaf-blindness and their families!
We encourage families to report a child/young adult (birth through age 21), request consent, and provide consent for exchange of information and records using the online Family Intake survey: https://ufl.qualtrics.com/jfe/form/SV_6fWdAe0jHvo8oxE
Educators and professionals may also make referrals using the Family Intake survey,
but consent must be provided by a parent/guardian for exchange of information and records.
Any family member or professional may report a child or young adult ( ages birth through 21) to the Florida deaf-blind registry by contacting FAVI at 1-352-273-7529.
PLEASE SUBMIT ALL FORMS WITH ANY IDENTIFYING INFORMATION (names, addresses, birth dates, etc.)
- BY FAX 352-273-8539
- OR Contact Shelly Voelker (firstname.lastname@example.org) for mailing instructions.
- Email is not a HIPAA-compliant means of exchanging protected information.
Referral Forms and Information
- For Families reporting their child with deaf-blindness
For educators and professionals reporting or updating a child/young adult record :
- Report a child or young adult to the deaf-blind registry
Once an individual has been reported to the Florida deaf-blind registry, a family, teacher, or educational team may request individualized assistance from the FAVI D-B Collaborative.
- Consent for the Exchange of Information & Records,
A parent/guardian needs to complete a Consent form, so that we can provide individualized information and services to a child or young adult with deaf-blindness, his/her family, and other educational team members.
Once a family has provided consent, any family member or team member may make a request for Technical Assistance (training, consultation, individualized support)
from the FAVI D-B Collaborative.
To request individualized assistance:
A family can provide information about their child/young adult, request assistance, AND provide consent ONLINE: https://ufl.qualtrics.com/jfe/form/SV_6fWdAe0jHvo8oxE
An educator or professional can make a request for assistance,
but family will need to provide Consent for the Exchange of Information and Records.
Request for Technical Assistance