Understanding Your Medicaid and Mental Health Rights Question Title * 1. Please complete the following registration information Name: Organization: Address: City/Town: ZIP: Email Address: Phone Number: Question Title * 2. Please Identify Collaborative Learning Opportunity You Are Registering For April 8 2019 10-1 Port Huron Question Title * 3. Please identify your affiliation Family member of a young child Family member of a teen or young adult Service provider works with young children Service provider works with teens or young adults Family member and service provider Individual with a disability Neighbor Religious Leader Community Member Question Title * 4. If you are a family member what is your relationship to the child, teen, young adult or individual with a special need and/or disability Parent (adoptive, biological, foster and step-parents) Grandparent Sibling Aunt/Uncle Niece/Nephew Cousin Individual with a Disability Question Title * 5. Do you need accommodations? Yes No Question Title * 6. If yes, what accommodations are needed? Mobility Visual Hearing Other Other (please specify) Next