WEST VIRGINIA
 COMMISSION FOR THE DEAF AND HARD OF HEARING
Application for Gubernatorial Appointment

Completed applications will be reviewed by, and nominees selected by, the Commission Board. Nominees selected will be asked to submit a background check form. Following background clearance nominees will be submitted to the Governor for appointment to the Board. This process can be lengthy and we appreciate your patience. If you have questions or need further information or assistance, please feel free to contact the Commission.


Name:
Address:
City: State: Zip: County:
Email:

Preferred method of contact:
Day Phone: Evening Phone: Fax:
Date of Birth: Sex: Race:


I am interested in serving on the Commission Board because:
 


 
My experiences and qualifications include: (Please attach resume' if available):


 
I have the following personal and/or professional experiences regarding the problems and needs of people who are deaf or hard of hearing:



The purpose of the West Virginia Commission for the Deaf and Hard of Hearing is to aid deaf and hard of hearing West Virginians in their efforts to live independent and productive lives and includes the following activities:

Maintain a clearinghouse of information to assist with obtaining appropriate services or information about such services;

Develop and conduct an outreach program to familiarize the public with the rights and need of persons who are deaf or hard of hearing;

Investigate the condition of deaf and hard of hearing persons in West Virginia with particular attention to those who are aged, homeless, needy, victims of rubella, and victims of abuse or neglect.

Establish, maintain and coordinate a service to provide a list of qualified and certified interpreters for the deaf; and a list of qualified and certified teacher of American Sign Language.
 

 

Members of the Board are appointed by the Governor. The Board must be comprised of at least five persons who are deaf or hard of hearing; a parent of a deaf child; a certified teacher of the deaf and hard of hearing; an audiologist; and an otolaryngologist. Applicants are requested to disclose the following information. Please check all that apply.








Three people who would recommend me for a position on the Board are:

Name: Address: Daytime Phone:
Name: Address: Daytime Phone:
Name: Address: Daytime Phone:

Questions regarding the Board or the application process may be directed to:  


Executive Director
WVCDHH
405 Capitol St., Suite 800
Charleston, WV 25301
(304) 558-1675 (Voice or TDD)
FAX (304) 558-0937