Department of Budget and Management

#17-009009-0004
Supplemental Questionnaire

Last Name
First Name

Please indicate your American Sign Language skill level

a. Polite (able to greet and exchange pleasantries; indicate or understand an emergency)

b. Literate (understands a conversation and can respond)

c. Fluent (is your native language or can converse in the language as if it was your native language.)

d. Do not speak sign language.

Do you have training in ASL/English bilingual strategies?

Yes No

Do you currently hold a Teacher Certification?

Yes No

If so, from what state?

Have you previously obtained Highly Qualified status from a school district?

Yes No