Sign Language Interpreting Service | Department on Disability

Appointment Date *

Month

Day

Year

Time *

Hour

:

Minute

am

pm

To *

Hour

:

Minute

am

pm

Requested By *

Phone Number *

Email Address *

Department *

Bureau *

Location of Event *

Address *

Room *

City *

State *

Zip Code *

Cross Street *

Parking *

On-site Contact Person *

Contact Number *

Contact Email Address *

Program Participant *

Situation *

Type of Interpreting Required (Check All That Apply) *

Document Sources and Special Instructions *

Hosting department will provide necessary materials such as Agenda, Program Outline, Script, and other pertinent information. Any and all material that can be provided to the service providers prior to the meeting will be appreciated. This ensures a more accurate interpretation/captioning. *Hosting department will need to provide Skype, Zoom, Google Hangouts, GoToMeeting, audio conference, or other video meeting access information such as Bridge Number, Zoom meeting Dial-In and ID numbers. Please expect further instruction on the next page after submitting the request.