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#21-009009-0015
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. Applications that do not include a completed supplemental questionnaire will be considered incomplete and may be subject to disapproval.***
1

Please 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

Do you hold a current license from the Maryland State Board of Examiners for Speech-Language Pathologists? If yes, please attach a copy with your application.
Yes No

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