Interpretation Service Request - Deaf Services Center

Interpreting Service Request

Name of Company(Required)

Building Address(Required)

Street Address Suite # City State / Province / Region ZIP / Postal Code Country

If virtual/remote services are requested, please list the platform to be used

If you intend to host the meeting, please include the virtual link

If you intend to record the session, please send consent forms in advance to interpreting@dsc.org

Do you prefer to have DSC establish the link on your behalf?

Yes

Consumer Name (non-English language user(s))(Required)

First Last

Provider Name/Person Consumer is Meeting: (English language user(s))(Required)

First Last

Language/Service Needed(Required)

PO Number or Authorization (if applicable)

Date of Service Request(Required)

Start Time

Please list actual service time needed

End Time

Please list actual service time needed

Nature/Purpose of Meeting(Required)

i.e. What will be discussed, who will be present, etc. This allows us to appropriately select the most qualified interpreter for your service need.

Special Instructions

i.e. parking instructions/validations, security check-in procedures, safety precautions, copy of presentation materials, etc.

Attachments

Max. file size: 50 MB.

i.e. parking instructions/validations, security check-in procedures, safety precautions, copy of presentation materials, etc.

Onsite Contact Name

First Last

Onsite Contact Phone

COVID or Other Precautions

Any additional pertinent details you would provide to a visitor at your facility?