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Nebraska Commission for the Deaf and Hard of Hearing

Deaf and Blind Communication Identification Card Application

General Information

I am / have: Please check all that apply.

Preferred Communication? (choose the most used)

To communicate effectively, I need : Please check all that apply.


Please do not take my assistive listening devices or communication devices away from me, because that device may be the best way for me to communicate.

None of these work perfectly, so if I still miss key words or instructions, please write them on a piece of paper for me in big block letters so that I can read them.

I am entitled to a qualified American Sign Language (ASL) interpreter for emergency medical proceedings and for police proceedings under the Americans with Disabilities Act and the Nebraska Statutes

Contact NCDHH to find an American Sign Language (ASL) Interpreter by calling 800-545-6244 or www.ncdhh.ne.gov

Don't take away my white cane as I need it to navigate my environment.

 
My name is:

I am/have:
To communicate effectively, I need:
Preferred Communication

Please do not take my assistive listening devices or communication devices away from me, because that device may be the best way for me to communicate.

None of these work perfectly, so if I still miss key words or instructions, please write them on a piece of paper for me in big block letters so that I can read them.

I am entitled to a qualified American Sign Language (ASL) interpreter for emergency medical proceedings and for police proceedings under the Americans with Disabilities Act and the Nebraska Statutes

Contact NCDHH to find an American Sign Language (ASL) Interpreter by calling 800-545-6244 or www.ncdhh.ne.gov

Don't take away my white cane as I need it to navigate my environment.

In case of emergency, contact: