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#18-002572-0037
Supplemental Questionnaire

Last Name
First Name

 

***Please note that your answers on the supplemental questionnaire must correspond to the information provided on your application to receive credit.***
1.

Please check the box below to indicate your American Sign Language skill level:
Polite (able to greet and exchange pleasantries; indicate or understand an emergency)
Literate (understands a conversation and can respond)
Fluent (is your native language or can converse in the language as if it was your native language)
Do not speak sign language.
2.

Please explain your experience using a video phone. If you do not have this experience, please enter N/A.

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