Braille Challenge - Regional Collateral Order Form

GENERAL INFORMATION

Host Agency:

Other Event Hosts/ Sponsors, if applicable:

Address of Regional:

Address Line 1

City

State / Province / Region

Postal Code

Country

Name of Regional Coordinator (main contact):

First

Last

Email

Phone

Regional Event Date:

Select Your Intended Program Delivery

Single Day In-Person Program
Testing Window – Individual Proctoring, Small Group Proctoring, and/or Virtual Proctoring

Please list your host agency's website link & social media handles:

Does your regional have contest production capabilities? (Meaning you can print/emboss all or some of your own contests)

Yes
No

PERMISSION FORM

Would you like to receive a customized electronic Permission Form (PDF)?

Yes
No

Note: Many regionals have opted to use digital Permission Forms using platforms like Google Forms, WordPress and Survey Monkey to collect the permission form information. You must make sure you are asking all the questions listed on our standard form, no exceptions. If this is the case, please note this in the “Notes” section below. And select “NO” here.

If not, will you be using a platform such as Google Forms, Microsoft Forms, or SurveyMonkey to collect permission forms?

Yes
No

Would you like your customized electronic Permission Form in both English and Spanish? Please mark below which language(s) you would like.

English
Spanish

What is your Permission Form due date?

Consent

By checking the box, you agree not to alter the content of the Permission Form. You may add regional program details and logistical questions as needed, provided the core content and order remains unchanged. Not following the required format may delay the Finalist announcement or disqualify eligible Finalists.

Additional Notes:

Will you be creating a digital Permission Form using a survey platform like Google Forms, WordPress, or Survey Monkey?*

Yes
No

Consent

🔲 By checking the box below, you agree not to alter the content of the Permission Form. If you are instead using a survey platform, you agree to review and follow the Digital Permission Form Template, ensuring all required content is included.

You may add regional program details and logistical questions as needed, provided the core content and order remains unchanged. Not following the required format may delay the Finalist announcement or disqualify eligible Finalists.

Braille Challenge – Regional Collateral Order Form

Braille Challenge 2027

Regional Collateral Order Form

GENERAL INFORMATION

PERMISSION FORM