California Connect, the CPUC's Deaf and Disabled Telecommunications Program formerly called the California Telephone Access Program, provides free specialized telephones and communication equipment to Californians with hearing, vision, speech, mobility or cognitive disabilities. The applicant completes page 1 and a certifying professional completes page 2. Services begin only after California Connect approves the certification.
The applicant gives contact details and disability type and signs under penalty of perjury. The certifying professional completes page 2: name, occupation, medical license number, business address, email and phone, and signature with date.
Download the current version from the source each time; forms change without notice.
California Connect Certification Form
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
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Medical doctors, physician assistants, nurse practitioners and Department of Rehabilitation counselors can certify any disability. Optometrists certify blind or low-vision applicants, audiologists and licensed hearing aid dispensers certify deaf or hard-of-hearing applicants, and speech-language pathologists certify speech disabilities. Certain California School for the Deaf audiologists can certify current students.
California Connect sends a letter or calls; blind and low-vision customers are contacted by phone first. The customer is then assessed for the equipment and services that fit their needs. No services begin until the certification form is approved.
Yes. The certification form is published in English, Spanish, Chinese, Hmong, Vietnamese and Russian. Customers can also request forms by phone or videophone in those languages, as well as Cantonese and American Sign Language.