Telecommunications Access for the Deaf and Disabled Administrative Committee
"*" indicates required fields
Applicant Consent
I certify under penalty of perjury that I meet the eligibility requirements including having a disability and that I am a current resident of the State of California.
I have read and fully understand the terms of this limited liability agreement and CPUC Privacy Policy. I acknowledge that I am signing the agreement freely and voluntarily and intend by my signature to be a complete and unconditional waiver, privacy consent and release of all liability, to the greatest extent allowed by law.
If you are not currently with a Medical Professional who can provide their signature, please select "No" to the question below and then click the "Next" button to continue your application.
To be completed by a Medical Professional
Professional Consent
I certify that the above-named person in the application meets the requirements of having a disability, which limits or prohibits the use of the telecommunication connectivity services, and cannot communicate without specialized equipment. I also certify that use of equipment and services for their disability could benefit this person.
If the information above is correct, please click on "Submit" to send your application to our team for further review.
