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Census of the Deaf and Hard of Hearing


     With the passage of House Bill 4510 on March 10, 2006, the WVCDHH is no longer required to maintain a census of persons who are Deaf and Hard of Hearing in the state. This amendment to the WV State Code is in compliance with federal privacy laws. WVCDHH encourages the voluntary submission of this information. Information is confidential and will only be shared with other agencies upon request in order to facilitate services to the deaf and hard of hearing clients.


 

Please provide the following information:

First Name Required
Middle Name
Last Name Required
Street address Required
Address (cont.)
City Required
County Required
Zip/Postal code Required     Format 99999-9999 
Work Phone Format (304)999-9999
Home Phone Format (304)999-9999
E-mail

Education highest completed:

Required

School(s) Graduated:

Year of Graduation:

Current Job Title:

Type of Hearing Loss:

(Click one.. ) Required
Both ears (Bi-lateral)
One ear (Unilateral)

(Click One.. ) Required
Conductive
Sensorineural
Mixed

Age of Onset:

Required

Specify Age if Onset was after Birth: 

Degree of Hearing Loss (in the better ear):

Required

Choose one of the following options:

Required

What kind of assistive devices do you use:

Hearing Aid(s) TTY
Cochlear Implant Real Time Captioning
Phone Amplications Other
None

 

Would you like to be on our mailing list to receive the Commission newsletters, announcements, and so forth?

Yes
No



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