Eligibility for the Complete Package is contingent on satisfaction of criteria and application approval.

First Name *

Last Name *

Email Address *

Deaf/Hard of Hearing Videophone Number * Enter numerical value only. No hyphens, periods, etc. Ex: 1110001111

SMS (Text) Number

Zip or Postal Code *

Describe Yourself * Unknown Deaf Deaf/Blind Hard of Hearing

Age Range * Under 18 years 18 to 24 years 25 to 34 years 35 to 44 years 45 to 54 years 55 to 64 years Age 65 or older

How will you use our services? * Home Work Both

Who is your internet service provider? * AT&T Bright House Century Link Charter Comcast COX Communications Frontier Google Fiber Hughes Net Spectrum Time Warner Verizon Other

Current Products Used * Convo DesktopConvo MobileP3 DesktopP3 mobileP70SmartVPSorenson DesktopSorenson mobileSorenson nVP1Sorenson nVP2Z5 DesktopZ5 MobileZ70 Please select all that apply.

Comments

Participants in the program are not required to place VRS and/or point-to-point video calls with ZVRS or Purple VRS. Participants will not be restricted to using ZVRS or Purple VRS service only with the Complete equipment.