Help Us Get To Know You!

Name *

First Name

Last Name

Phone *

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How would you best describe your dDeafness / hearing loss *

I am Hard of Hearing

I am profoundly dDeaf

I have fluctuating hearing loss

I am Late dDeafned

I am DeafBlind

I am DeafDisabled

I am just begining my hearing loss journey—still figuring it out!

I have Unilateral dDeafness / hearing loss

Do you use any assistive listening devices? *

I use behind the ear (BTE) hearing aid(s)

I use a cochlear implant and a behind the ear (BTE) hearing aid

I use cochlear implant(s)

I use bone anchored hearing aid(s) (BAHAs)

I do not use assistive listening devices

Which of the following best describes where you are in your dDeafness / hearing loss journey? *

I'm curious, but a bit intimidated

I'm just getting started, but excited!

I haven't really thought about my deaf diagnosis

I have an idea of what my dDeaf/HoH Identity means to me, but looking for helpful resources and direction

I am confident in my dDeaf/HoH Identity, but looking for helpful resources and encouragement

What are your communication preferences? *

I prefer to use spoken English with captions

I prefer to use SimComm (spoken English and American Sign Language) with captions

I prefer to use American Signed Language