Application for
Board for Evaluation of Interpreters
Advisory Board Membership
The Health and Human Services Commission is seeking applications for the Board for Evaluation of Interpreters Advisory Board. The board consists of seven members appointed by the HHS executive commissioner.Boardmembers must be a Texas resident and must meet one of the following categories:
- An applicant who is deaf, a frequent consumer of interpreting services and demonstrates knowledge of the field of interpreting and linguistics as well as has a unique understanding for the demographics and dynamics of Texas' Deaf Community.
- An applicant who is deaf and holds a valid BEI Intermediary - Level III certificate, an Intermediary - Level V certificate or a BEI Certified Deaf Interpreter Certificate.
- An applicant who is hearing and holds a valid BEI Advanced or Master certificate or who has actively engaged in the profession of interpreting for at least three of the immediate past five years.
If you wish to apply to be a member of the board, please fill out this application. The boardwill advise HHSC on matters relating to the administration of the statewide interpreter certification program. This includes assisting HHSC with the evaluation and certification of sign language interpreters for Texans who are deaf and hard of hearing; developing, subject to HHSC's approval, qualifications for each of several levels of certification based on proficiency; and reviewing complaints, as identified by the Office of Deaf and Hard of Hearing Services, filed against BEI-certified interpreters in order to make recommendations on revoking or suspending a certificate or placing a certificate holder on probation for a violation of a statute, rule or departmental policy.
If a question does not apply to you, enter “N/A.”
Please attach a résumé and a five-minute video clip in American Sign Language listing your relevant personal and professional achievements to include current licensures and activities that address contributions you could make to the board.
HHSC will use the information you put on this application, your video clip and your resumé to decide if you are eligible to serve on this board.
Important note: Meetings will be held in Austin. Board members are not paid to attend meetings but may be reimbursed for their travel to and from meetings if funds are available.
HHSC won’t consider an application received after April 1.
SECTION 1 - Personal Information
1
Name:
Home Address:
City: State: TXZIP: Phone:
Fax:Email:
Employment Information (If applicable)
Business/Organization:
Address:
City:State: TXZIP: Phone:
Fax:Email:
Current Position Title:
1
Please check where you would like to receive further communications:
1
Work Email Home Email Work Address Home Address
Application
New/Initial ApplicationRenewal Application
Gender
MaleFemale
Race/Ethnicity
American Indian/Alaskan Native Asian/Pacific Islander
Black Hispanic
White Other
1
SECTION 2
A person may apply to be on this board. Professional applicants include: providers, professional associations, non-profit organizations, managed care organizations and other subject matter experts.
You must attach a résumé, a five-minute video clip addressing the following questions and certification (if applicable).
Describe what you can contribute to the board.
1
Please tell us why you want to serve on this board.
List your relevant personal and professional achievements, including current licensures and activities that address contributions you could make to the board.
1
Have you ever been disciplined by any licensing board or professional or civic organization, including the HHSC Inspector General?
1
No Yes
If yes, please explain:
1
SECTION 3
State law requires that the board include at least one person to represent each of the following categories. Please check the category you would like to apply for. You may select more than one category that applies to you.
1
1
An applicant who is deaf, a frequent consumer of interpreting services and demonstrates knowledge of the field of interpreting and linguistics as well as has a unique understanding for the demographics and dynamics of Texas' Deaf Community.
1
1
An applicant who is deaf and holds a valid BEI Intermediary - Level III certificate, an Intermediary - Level V certificate or a BEI Certified Deaf Interpreter Certificate.
1
1
An applicant who is hearing and holds a valid BEI Advanced or Master certificate or who has actively engaged in the profession of interpreting for at least three of the immediate past five years.
Member Participation
Every member appointed to the board must attend regularly and must participate in board activities.
- The term of service for this board is three years. Members who must leave the board before their term of service has expired, are asked to notify HHSC staff in writing 30 days prior to their exit.
- Regular board meetings are held about once every three to four months. The presiding officer may also call a special committee meeting. Members must travel to Austin for these meetings.
- Board meetings may happen at other times. Members must travel to Austin for these meetings or participate by phone. Each meeting may last several hours.
Do you believe you will be able to regularly participate in board activities, if you are appointed?
1
No Yes
If no, please explain:
1
Miscellaneous Information
Do you have a personal or private interest in a matter pending before HHSC? ("Personal or private interest" means you have a direct monetary interest in the matter or owe your loyalty to an entity involved, but does not include the member's engagement in a profession, trade or occupation when the member's interest is the same as all others similarly engaged in the profession, trade or occupation.)
1
NoYes
Have you ever been convicted of a felony or misdemeanor (excluding traffic violations)?
No Yes
If yes, please explain:
1
References
Please provide the names and contact information for two people who can tell us more about your qualifications to serve on the board. References can include employers, clients, religious leaders, community leaders, advocates, friends or others who know about your interest in or involvement with service delivery through Medicaid. If you are applying as a provider, include at least one client reference.
Reference #1
1
Name:
Address:
City: State: ZIP:
Daytime Phone:
Email:
Relationship (how this person knows you):
Reference #2
Name:
Address:
City: State: ZIP:
Daytime Phone:
Email:
Relationship (how this person knows you):
1
All the information contained in this application is true and correct. I understand that the board will meet in Austin, Texas,at least three to four times per year. If selected, I will make every effort to attend all board meetings.
1
Signature (typed name is acceptable)Date
1
Please return this form and any supporting documentation by April 1, 2018to:
Email:
Attn: Lori Breslow, Director
Mail: Texas Health and Human Services Commission
P.O. Box 12904, Mail Code 3027
Austin, TX 78711
Attn: Lori Breslow, Director
Fax: 512-407-3299
Attn: Lori Breslow, Director
If you have any questions about the application or the BEI Advisory Board, please contact Lori Breslow at 512-407-3250 or by email at .
1