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Form
Identification Tool for Communication Access Services for Individuals Who Are Deaf, Late-Deafened, Hard of Hearing, Deaf-Blind Low-Vision, Speech-Impaired
Name:
Date of Birth:
E-mail:
As a client of DHHS I need the following type of communication access for my meeting with a DHHS staff person:
ASL Sign Language Interpreter
Signed English Interpreter
Certified Deaf Interpreter
Deaf-Blind Interpreter
CART Services (Real Time Captioning)
Cued Speech Interpreter
Deaf-Low Vision Interpreter
Large Print Version
CD Version of Printed Information
Assisted Listening Device
Braille Version
Laptop to Type On (for client with speech impairments)
other
Interpreters who are suitable for my meeting with the DHHS Staff Person include:
Please do not contact these interpreters for my meeting: