NC Division of Services for the Deaf and Hard of Hearing (DSDHH) is now accepting requests for ClearMask™ samples for Deaf, Hard of Hearing, and DeafBlind NC residents and professionals that actively serve them. DSDHH cannot guarantee how the product will perform and is not responsible for any type of misuse as well as individuals becoming affected with COVID-19.

THIS PROGRAM IS ONLY AVAILABLE TO NC RESIDENTS.

Answer all questions on the form to ensure your request is complete. We will use the mailing address for shipping the ClearMask™ to you. If you have trouble using this form, contact your local regional center for assistance.
Find a Regional Center near you.

Question Title

* 1. Please enter your contact information below to be added to receive clear masks. Please reply "N/A" to items which do not apply.

Question Title

* 3. Type of phone number provided above:

Question Title

* 4. Which of the following best describes the individual(s) whom will be ordering the masks? Check all that apply.

Question Title

* 5. If you are a Provider which of the following best describes you? Check all that apply.

Question Title

* 6. Do you plan to use these masks yourself or for others who interact with you?

Question Title

* 7. Would you like to be on our mailing list where you will receive via email, information about monthly regional events and the Deaf, Hard of Hearing, and DeafBlind community?

T