Department of Budget and Management

#18-009009-0025
Supplemental Questionnaire

Last Name
First Name

Please indicate your American Sign Language skill level:

a. Polite (able to greet and exchange pleasantries; indicate or understand an emergency)

b. Literate (understands a conversation and can respond)

c. Fluent (is your native language or can converse in the language as if it was your native language.)

d. Do not speak sign language.

Do you currently have a Certificate of Clinical Competence in Audiology? If so, please attach a copy with your application.

Yes No