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#18-009014-0005
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.

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