TTY LOAN

Telephonic Communication Device
Loan Program
1- 866- 461- 3578, (304) 558-1675 (V/TTY), (304) 558-0937 FAX

Notice: Records relating to recipients of the WV Commission for the Deaf and Hard of Hearing are confidential except for those portions defined by the state law as public information.

To find out the extent to which the information provided on this application form may be released to other individuals, institutions, or agencies consult the West Virginia Commission for the Deaf and Hard of Hearing. Also, please read Return of Equipment information provided.

Please print and complete the six-page application form TCD Application Form and WV Census Form send to the WVCDHH by mail. A copy of a valid driver’s license with a legible deaf or hard-of-hearing designation may be substituted for page 6.

Make sure the "ear" is clearly visible on the copy. If a copy of a driver’s license with the deaf or hard-of- hearing designation is submitted, a copy of an audiogram or hearing test is not required.
If you are applying for a low vision device, please also complete Visual Impairment Form

CHECKLIST:

____TCD Application Page 1-5 (Required)

____Page 6 OR driver’s license with deaf or hard-of-hearing designation

____Copy of hearing test or audiogram (may be omitted with driver’s license)

____WV Census Form

____Low-Vision Form (Optional)

Available devices:

Amplified Phone - adjustable volume and clarity for the hard of hearing
TTY - device for the deaf that requires writing and typing to communicate with those
who have a TTY or by using the WV Relay system

Low-Vision Amplified Phone - Amplified phone with large numbers for easier dialing

Low-Vision TTY - TTY with large display for the vision impaired