AGE Iowa Midwest Nation N % N % N % Total students Information NOT reported

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1 * ext 5575 Page 1 of 9 AGE Iowa Midwest Nation Information NOT reported Total known information Under 3 years From 3 to 5 years From 6 to 9 years From 10 to 13 years From 14 to 17 years years and older SEX Iowa Midwest Nation Information NOT reported Total known information Male Female RACE/ETHNIC BACKGROUND Iowa Midwest Nation Information NOT reported Total known information White Black/African-American Hispanic/Latino American Indian/Alaska Native Asian/Pacific Islander Other Multi-ethnic background indicated

2 * ext 5575 Page 2 of 9 AGE AT ONSET OF HEARING LOSS Iowa Midwest Nation Information NOT reported Total known information At birth Under 3 years years or older Unknown AGE AT ONSET OF HEARING LOSS Iowa Midwest Nation Information NOT reported Total known information At Birth Under One Year Unknown, but befroe age Unknown year of age years of age years of age years of age years of age years of age years of age years of age

3 * ext 5575 Page 3 of 9 ETIOLOGY ** Iowa Midwest Nation Information NOT reported Total Known Information Genetic/Hereditary/Familial Pregnancy Related Maternal rubella Cytomegalovirus (CMV) Maternal drug/alcohol abuse Medications taken by mother Rh incompatibility Consequence of prematurity Trauma at birth Other complications of pregnancy Post-Birth Disease/Injury Otitis media Meningitis Other infections Medications taken by child Trauma after birth Other post-birth cause Cause cannot be determined/dna SPECIFIC GENETIC CAUSE OR SYNDROME Iowa Midwest Nation Total students Information NOT reported Total known information Waardenburg syndrome Usher syndrome Treacher syndrome Down syndrome CHARGE sydnrome Chromosome abnormality Connexin-26 (GJB2) Other ** Percent may total more than because multiple responses were allowed + New question for the survey year

4 * ext 5575 Page 4 of 9 PARENTAL HEARING STATUS Iowa Midwest Nation Information NOT reported Total known info., Either Parent Mother s status: Hearing Hard of hearing Deaf Unknown Father s status: Hearing Hard of hearing Deaf Unknown Both parents hearing Both parents deaf or hard of hearing One parent deaf/hh; other hearing One parent deaf/hh; other unknown One parent hearing; other unknown HAS DEAF OR HARD OF HEARING SIBLINGS Iowa Midwest Nation Information NOT reported Total known information Has deaf or hard of hearing siblings Has no deaf or hard of hearing siblings Data Not Available

5 * ext 5575 Page 5 of 9 UNAIDED AUDIOMETRIC THRESHOLDS Iowa Midwest Nation MEASUREMENT Information NOT reported Total known information Earphone (preferred measurement) Sound field ABR DEGREE OF HEARING LOSS Iowa Midwest Nation Information NOT reported Total known information Normal (< 27 db, ANSI) Mild (27-40 db, ANSI) Moderate (41-55 db, ANSI) Mod-severe (56-70 db, ANSI) Severe (71-90 db, ANSI) Profound (91 db and above, ANSI) COCHLEAR IMPLANT Iowa Midwest Nation Information NOT reported Total known information Have not had a cochlear implant Have had a cochlear implant Implant Use Total students Information NOT reported Total known information Implant still used Implant no longer used New question for the survey year

6 * ext 5575 Page 6 of 9 COCHLEAR IMPLANT USE IN CLASSROOM Iowa Midwest Nation Total students Information NOT reported Total known information Implant used in classroom Implant not used in classroom FUNCTIONAL HEARING ABILITY Iowa Midwest Nation Information NOT reported Total known information Functions normally Mildly limited Moderately limited Severely limited No functional hearing HEARING AID USE FOR INSTRUCTION Iowa Midwest Nation Information NOT reported Total known information Hearing aid used for instruction Hearing aid not used for instruction GROUP ASSISTIVE LISTENING DEVICE(ALD)USE Iowa Midwest Nation Information NOT reported Total known information Group ALD used for instruction Group ALD not used for instruction

7 * ext 5575 Page 7 of 9 SPOKEN/WRITTEN LANGUAGES IN THE HOME Iowa Midwest Nation Information NOT reported Total known information English Spanish Other Multiple languages SIGN USE IN THE HOME Iowa Midwest Nation Information NOT reported Total known information Family members regularly sign Family members do not regularly sign Data not available COMMUNICATION MODE PRIMARILY USED Iowa Midwest Nation IN TEACHING Information NOT reported Total known information Speech only Sign and speech Sign only Cued Speech Other

8 * ext 5575 Page 8 of 9 INSTRUCTIONAL SETTINGS ** Iowa Midwest Nation Information NOT reported Total known information Special school or center Self-contained clrm in req. ed. setting Resource room Regular education setting Home Other HRS/WK INTEGRATED W/HEARING STUDENTS Iowa Midwest Nation Information NOT reported Total known information None to 5 hours/week to 15 hours/week to 25 hours/week or more hours/week ABR Results Iowa Midwest Nation Information NOT reported Total known information ABR results are not available/reliable Response absent at 30 db nhl Response absent at 40 db nhl Response absent at 50 db nhl Response absent at 60 db nhl Response absent at db nhl Response absent at 100+ db nhl ** Percent may total more than because multiple responses were allowed + New question for the survey year

9 * ext 5575 Page 9 of 9 SUPPORT SERVICES RECEIVED ** Iowa Midwest Nation Information NOT reported Total known information No support services Sign interpreting Oral interpreting Cued speech transliteration Itinerant teacher services Tutoring Classroom inst. ass t/aide services Adaptive PE Speech training/therapy Auditory training Counseling Occupational/Physical Therapy (OT/PT) Notetaking Real-time captioning Other ADDIT. CONDITIONS OTHER THAN DEAFNESS** Iowa Midwest Nation Information NOT reported Total known information No condition in addition to deafness Low vision Legal blindness Developmental delay Autism Orthopedic impairment(includes CP) Learning disability (LD) Attention Deficit Disorder (ADD/ADHD) Speech or language impairment Traumnatic brain injury Mental retardation Emotional disturabance Other health impairment Other conditions ** Percent may total more than because multiple responses were allowed