Your Information:

First Name:
*
Last Name:
*
Department/Student Organization/Event Sponsor making the request:
*
Contact person:
*
Contact Address:

Contact phone number:
*
Contact Fax:

Contact Email:
*
Alternative contact person:
*
Alternative phone number:
*

Student/Employee/Guest Information:

Name of the Deaf Student/Employee/Guest:
*

Date of event the interpreter is needed:

Start Date:
*
End Date:
*
Start Time:
1 2 3 4 5 6 7 8 9 10 11 12 : 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59    AM PM *
End Time:
1 2 3 4 5 6 7 8 9 10 11 12 : 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59    AM PM *
Multiple days: Yes No *

Location of event:

Building:
*
Room number:
*
Other details for location:

Parking Lot/Information:

Class/Meeting/Event Type:
(please check the appropriate box)

Class
Meeting
Job Interview
Student services appointment (financial aid, admissions, or other department)
Student Organization
Campus Event(give details in the comment section)
Others(give details in the comment section)

Expected atire for this event:
(please check the appropriate box)

Formal
Business casual
Casual
Other

What type of interpreting or service does the Student/Employee/Guest requesting? *
(please check the appropriate box)

American Sign Language
Signed Englishe
PSE
Voicing
Oral Interpreters
Real-Time Captioning
FM systems

Comments:


By checking this box, you agree to the terms and procedures below:
A fax or email will be sent to your office to confirm your request and give you an approximate cost of the assignment. In the event that the Center for Students with Disabilities is unable to provide an interpreter, your office will be notified as soon as possible, no later than 24 hours (1 business day) before the scheduled assignment. If your organization needs to cancel this request, Center for Students with Disabilities must be notified as soon as possible, no later than 48 hours (2 business day) prior to assignment if the interpreter is a CSD interpreter. If we have booked you with a contract interpreter or agency you must contact them directly, contact information will be provided to you. If cancellation notification is not made, CSD, the contract interpreter or agency will bill for the total amount of your request.