DEAF HEALTH COMMUNICATION and QUALITY OF LIFE CENTER
Participate in HINTS-ASL Project
What is your first name?
What is your last name?
What is your phone number (VP)?
What is your e-mail address?
What is your birthdate?
Are you male or female?
What is the highest level of education you have completed?
Did Not Complete High School
Advanced Graduate work or Ph.D.
What is your martial status?
Which language do you prefer?
American Sign Language
What is your hearing status?
Hard of Hearing
Which of the following race or races do you identify with?
American Indian or Alaska Native
Black or African American
Native Hawaiian or Pacific Islander
Which state do you live in?
a cancer patient or survivor
a loved one of a close friend or family member who have or had cancer. (you helped take care of this person)
none of the above