Telephone - Give applicant's home or business telephone number. This telephone number must be the number with which the applicant will be using a specialized telecommunications device or service. The number must match the phone bill for home or business. Social Security Number - Give applicant's social security number as listed on the social security card. Describe Disability - Give additional information about applicant's disability for the type of device or service requested or needed if necessary.
Additional space is available on the back of the application.
Verification of access to a telephone line - Check to show how applicant will verify that applicant has a telephone. Verification of Texas Residency - Mark one type of identification and submit a copy. This verification must be current and correct and match the information on the application. Applications must have original signatures to be valid. Certifier's profession - Mark one professional category that pertains to you.