Interpreter Request Form

I'm an existing customer making a new Sign Language / CART request. I'm a new customer interested in Sign Language / CART InterpretingI'm cancelling a previously confirmed Sign Language / CART request. I'm updating a previously confirmed or pending request.

Job numbers are located in the subject line of the confirmation email.

Yes, I'll input the request below!No, I'm finished.

Please ensure that all pertinent details requiring updates are included in your request. Providing comprehensive information will facilitate a more efficient process.

Sign Language InterpreterCART (Captioning Services)Specialized Interpreter (Tactile, Trilingual, CDI) Check more than one if requesting different types of interpreters

Put NA if Not Applicable

MondayTuesdayWednesdayThursdayFridaySatrudaySunday

Please note the time requested will be considered billable time.

Leave this blank if there isn’t.

Please describe the appointment type and setting.

Instead of “doctor’s visit” or “need ASL interpreter,” include details like:

§ “Doctor’s visit for liver consultation”

§ “College class on chemistry lab safety”

§ “Mental health intake for anxiety”

§ “Parent-teacher conference for a 3rd-grade student”

Please include any logistical details that will help the interpreter arrive and connect smoothly. Use Examples such as:

o Parking instructions (garage name, validation, gate codes)

o Exact meeting location (room number, front desk, specific entrance)

o Check-in process (security desk, badge pickup, escort required)

o Any access notes (e.g., “Use side entrance near pharmacy” or “Meet in Room 204, 2nd floor of Building B”)

These resources are essential for ensuring accurate and effective communication access for all participants

One TwoThreeFour Or MoreNA (Request for General Acessibility)

no need to enter if you do not know this information

Needs Name, Phone, and Email address (If Possible)

Receiving Services -The Deaf individual is receiving care, instruction, or support (e.g., patient, student, client, interviewee).Providing Content- The Deaf individual is leading, presenting, or performing (e.g., speaker, workshop leader, performer). Participating in a Group -The Deaf individual is actively engaged in a shared activity or discussion (e.g., parent in a school meeting, therapy participant, team member).

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