ASL Interpreter Request Form

Please Note, that sending a request to the DSS Office does NOT mean that Interpreters are automatically scheduled for you. Someone from DSS will contact you about this request for additional information. You will receive a confirmation email at submission, but please allow five working days for your request to be processed.

Date of Request:	mm/dd/yy
Name of person or group requesting Interpreters:
Department or School with which affiliated:
Phone Number:
Fax:
Email Address:
Org and Fund (if appropriate):
Title of Event:
Date of Event:	mm/dd/yy
Location of Event:
Start Time of Event:
End Time of Event:
Name of person request is for:
	Because you will want information communicated accurately, the Interpreter must have accurate information. By providing this information before the event, Interpreters will be better prepared to interpret smoothly. Therefore, below please provide information for scripts, set play-lists, lecture notes, names/pronunciations of speakers, etc. to add in the coordination of scheduling Interpreters for your event.
Additional Information: