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Apply to Qualify

Need to apply for an accessible phone, TTY, or other specialized piece of communications equipment for your own personal use at no cost to you? The process is fast and easy!
Need Help filling out your application?
Give us a call at 1-800-806-1191
  • A black man wearing a gold long sleeve shirt wearing a headset and microphone device to communicate with others.
  • A female young adult wearing rainbow tie dye sweatshirt, looking afar from her wheelchair, holding an iPad device in her hand.
  • An Asian man with black-rimmed glasses and hair, long sleeve plaid shirt and a green t-shirt, listening through a device and smiling.
  • A white Deaf man wearing a gold hat and gold-rimmed glasses. The man is wearing a tan t-shirt and has a flower tattoo on his left neck.
  • A blind Black woman wearing a white turtleneck shirt and blouse sitting on the couch, holding a white phone to her ear, listening to the caller on the other end of the line.

Download Application

1. Download, print, and complete Section 1 of the Certification Form PDF in your desired language, if available:

Download the PDF form and Complete Section 1:

Note: Use only Acrobat Reader to complete the PDF Form.

Request a Form by Mail:
You also may request a Certification Form in your desired language by mailing to the State of California California Connect Contact Center at P.O. Box 30310 in Stockton, CA 95213.

Request a Form by Phone/VP:
You also may contact us at 1-800-806-1191 in the following languages of English, Spanish, Mandarin, Cantonese, Hmong, Vietnamese, Russian, and ASL to request a form.

  • English: 1-800-806-1191
  • Spanish: 1-800-949-5650
  • TTY: 1-800-806-4474
  • Mandarin: 1-866-324-8747
  • Cantonese: 1-866-324-8754
  • Hmong: 1-866-880-3394
  • Vietnamese: 1-855-247-0106
  • Russian: 1-855-546-7500
Call 1-800-806-1191

2. Contact your preferred Professional to complete and sign Section 2 of the form:

The following medical professionals are authorized by the State of California to sign Section 2:

  • Licensed Medical Doctor: May sign for people with any disability.
  • Licensed Physician Assistant: May sign for people with any disability.
  • Licensed Nurse Practitioner: May sign for people with any disability.
  • Department of Rehabilitation Counselor [VRC, RCB or RCD]: May sign for people with any disability.
  • Licensed Optometrist: May only sign for people who are blind or partially-sighted.
  • Licensed Audiologist: May only sign for people who are deaf or hard of hearing.
  • Licensed Speech Language Pathologist (SLP): May approve applications for applicants with speech disabilities.
  • Superintendent or school audiologist at the California School for the Deaf in Riverside and Fremont: May only sign for current students who are deaf or hard of hearing.
  • Licensed Hearing Aid Dispenser: Dispenser must have the customer record on file, and may only sign for people who are deaf or hard of hearing.

If you do not have a doctor, you may stop in and visit one of our service centers or call us for assistance in finding a certified medical professional who could sign your Certification Form.

3. Mail, Email, or Fax your completed Certification Form to a California Connect Contact Center:

By Mail:
State of California California
Connect Contact Center
P.O. Box 30310
Stockton, CA 95213

By Email:

By Fax:

OR drop off your Certification Form at one of the California Connect Service Centers:

View the Service Center Location and Hours.

All California Connect Service Centers are open Monday through Friday, 8:00 AM – 5:00 PM (excluding holidays), except Marina, San Francisco, San Jose, Santa Barbara, West Covina and Redding. Please call the Contact Center at 1-800-806-1191 to confirm hours of operation for all Service Centers.

Once your Certification Form is approved, you will receive a letter or call. California Connect will contact low-vision and blind customers by phone before sending a letter. The letter or call will instruct you to either get in touch with the California Connect Contact Center or visit a California Connect Service Center. You will be assessed for the best equipment and services to meet your needs. Additional training is also available by getting in touch with the California Connect Contact Center or visiting a California Connect Service Center.

Go here to see equipment  grouped by approved certification.

Let California Connect know if there is some way to help improve the application process by filling out the Program Feedback Form.

To view pdf forms, download the most recent version of Acrobat Reader.


Contact Center
P.O. Box 30310
Stockton, CA 95213
Phone/VP: 1-800-806-1191
Fax: 1-800-889-3974


Welcome to California Connect, also called the Deaf and Disabled Telecommunications Program (DDTP), which provides communication access for Californians with hearing, vision, cognitive, mobility, and speech-related disabilities. The program of the California Public Utilities Commission (CPUC) includes accessible communication equipment and devices, relay service, and Augmentative and Alternative Communication (AAC) devices.
Copyright © 2024 State of California