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Washington State Department of Social and Health Services
Home and Community Living Administration
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ALTSA
Office of Deaf and Hard of Hearing
Resource
SECTION 1. Information
First Name
Last Name
Country:
USA/Canada:
Other:
Address Line 1:
Address Line 2:
City/Town
State:
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
AB
BC
MB
NB
NF
NT
NU
NS
ON
PE
QC
SK
YT
Zip Code:
County of Residence:
Adams
Asotin
Benton
Chelan
Clallam
Clark
Columbia
Cowlitz
Douglas
Ferry
Franklin
Garfield
Grant
Grays Harbor
Island
Jefferson
King
Kitsap
Kittitas
Klickitat
Lewis
Lincoln
Mason
Okanogan
Pacific
Pend Oreille
Pierce
San Juan
Skagit
Skamania
Snohomish
Spokane
Stevens
Thurston
Wahkiakum
Walla Walla
Whatcom
Whitman
Yakima
Other
ALL
N/A
Phone:
Voice
TTY
VP
Text
FAX
E-mail Address
SECTION 2. Demographic Profile (Optional)
Hearing Identity:
---
Deaf
Deaf & Hard of Hearing
Deaf/Low Vision
DeafBlind
DeafDisabled
Hard of Hearing
Hard of Hearing/Blind
Hard of Hearing/Low Vision
Hearing
Late Deafened
Other
Gender:
Male
Female
Transgender
Other
Prefer not to disclose
Trans Man/Transgender Male/Female-to-Male(FTM)
Trans Woman/Transgender Female/Male-to-Female(MTF)
Non-binary
Genderqueer
Ethnicity/Race:
Are you of Hispanic origin?
Yes
No
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):
American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or Pacific Islander
Other Race
White
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:
---
CDI
CDI-P
CI
CI and CT
CLIP
CLIP-R
Close vision
CSC
CT
IC
IC/TC
MCSC
NAD I
NAD II
NAD III
NAD IV
NAD V
NIC
NIC Advanced
NIC Master
OIC:C
OIC:S/V
OIC:V/S
OTC
Pre-certified
ProTactile
Prov. SC:L
QDI
RSC
SC:L
SC:PA
Tactile
TC
---
CDI
CDI-P
CI
CI and CT
CLIP
CLIP-R
Close vision
CSC
CT
IC
IC/TC
MCSC
NAD I
NAD II
NAD III
NAD IV
NAD V
NIC
NIC Advanced
NIC Master
OIC:C
OIC:S/V
OIC:V/S
OTC
Pre-certified
ProTactile
Prov. SC:L
QDI
RSC
SC:L
SC:PA
Tactile
TC
---
CDI
CDI-P
CI
CI and CT
CLIP
CLIP-R
Close vision
CSC
CT
IC
IC/TC
MCSC
NAD I
NAD II
NAD III
NAD IV
NAD V
NIC
NIC Advanced
NIC Master
OIC:C
OIC:S/V
OIC:V/S
OTC
Pre-certified
ProTactile
Prov. SC:L
QDI
RSC
SC:L
SC:PA
Tactile
TC
---
CDI
CDI-P
CI
CI and CT
CLIP
CLIP-R
Close vision
CSC
CT
IC
IC/TC
MCSC
NAD I
NAD II
NAD III
NAD IV
NAD V
NIC
NIC Advanced
NIC Master
OIC:C
OIC:S/V
OIC:V/S
OTC
Pre-certified
ProTactile
Prov. SC:L
QDI
RSC
SC:L
SC:PA
Tactile
TC
---
CDI
CDI-P
CI
CI and CT
CLIP
CLIP-R
Close vision
CSC
CT
IC
IC/TC
MCSC
NAD I
NAD II
NAD III
NAD IV
NAD V
NIC
NIC Advanced
NIC Master
OIC:C
OIC:S/V
OIC:V/S
OTC
Pre-certified
ProTactile
Prov. SC:L
QDI
RSC
SC:L
SC:PA
Tactile
TC
---
CDI
CDI-P
CI
CI and CT
CLIP
CLIP-R
Close vision
CSC
CT
IC
IC/TC
MCSC
NAD I
NAD II
NAD III
NAD IV
NAD V
NIC
NIC Advanced
NIC Master
OIC:C
OIC:S/V
OIC:V/S
OTC
Pre-certified
ProTactile
Prov. SC:L
QDI
RSC
SC:L
SC:PA
Tactile
TC
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