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#18-009014-0003
Supplemental Questionnaire

Last Name
First Name
1.

Please check the box below to indicate your American Sign Language skill level:

Polite (able to greet and exchange pleasantries; indicate or understand an emergency)
Literate (understands a conversation and can respond)
Fluent (is your native language or can converse in the language as if it was your native language)
Do not speak sign language.

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