Home and Community Living Administration

SECTION 1. Information

First Name  
Last Name  
Country: USA/Canada: Other:
Address Line 1:
Address Line 2:
City/Town  
State:
Zip Code:
County of Residence:
Phone:
 
E-mail Address  

SECTION 2. Demographic Profile (Optional) 

Hearing Identity:
Gender:
 
Ethnicity/Race:
Are you of Hispanic origin?
The Spanish/Hispanic/Latino/Latinx question is about ethncity, not race. Please continue to answer the following question by marking one or more boxes to indicate what you consider your race be (check all that apply):



SECTION 3. Directory of Interpreter

(If you are a sign language interpreter and want your profession information to be published under DSHS website then please fill below. Your interpreter name, certification, email, phone number, and residence of county will be shown in the directory of interpreter. )
Yes, I want my profession to be on ODHH Directory of Interpreter.
Allow ODHH to share your name for any BIPOC-related inquiries.
Certification/Interpreting Skills:
I am willing to interpret in the following area of interest (check all that apply):

Mental Health
Drug and Alcohol
Children Protective Service
Adult Protective Service
Medical
Socio-Economics Benefits
Platform
K-12 Education
Post-Secondary Education
Rehabilitation/Vocational
Adult Education
Technology
Legal:
Court
Administrative Hearing
Law Enforcement