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Nebraska Specialized Telecommunications Equipment (NSTEP)
Information Request Form

Fill out this form if you would like for the Nebraska Commission for the Deaf and Hard of Hearing to send you an application for the Nebraska Specialized Telecommunications Equipment in the mail.

Information received from the submission of forms that are posted on the Nebraska Commission for the Deaf and Hard of Hearing (NCDHH) web site, is used for business use only. Information collected through the submission of forms will not be resold for commercial use, all information will be kept confidential.

Entries marked with an * is required information.

(include the 4 digit extension)

(include area code)




I am:

I currently use:

I would like to receive information about the services offered by NCDHH:

I would like to receive information about the Nebraska Relay Service:

Would you like for your name to be added to the Nebraska Commission for the Deaf and Hard of Hearing's Registry that tracks the number of deaf/hard of hearing people who live in Nebraska? *

 

Thank you for your time in completing this form.

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