Interpreter Request Form

Please fill out each section as completely as possible. We understand that sometimes you may not have all the information we need, so although we need to know everything we are asking for, we have tried to limit the number of required fields. If you submit an incomplete form, we will contact you later to get the rest of the information.

Client Information

Are you a new client, or an established client? * New ClientEstablished Client (A written agreement is on file with Words for the Eyes, LLC.)

Requester Information

Organization Name *

Requester Name *

Requester Email Address *

Requester Phone Number: *

Is the Requester also the Billing Contact Person? * YesNo

Billing Information

Billing Contact Name *

Billing Contact Email Address *

Billing Contact Phone Number

Is this request for college/university or K-12 classes? * YesNo

Is this a request for college/university or K-12 classes? * YesNo

Assignment Details - Event for New Client

Date(s) of Assignment * Please enter starting & ending dates and days of the week if applicable.

Beginning Time - Ending Time *

Event Description *

Hearing Participant(s)

Deaf/Hard-of-Hearing Participant(s)

Type of Interpreting (if known)

Assignment Location Please include room number and building name.

Assignment Street Address

City

State

Zip Code

Location Phone Number

Is the Requester also the on-site contact person? * YesNo

Requester Phone Number on Day of Event (if different from regular phone number).

Onsite Contact Person

Contact Phone Number (if different than location phone number)

Remarks - Please include any additional information about the assignment here. Make sure to include any important information about parking or special instructions for building entry.

Please upload any files that will help the interpreter to prepare for the event. We will forward these files to the interpreter for you.

Assignment Details - Classes for New Client

Unless class schedules are identical, please complete one form for each Deaf/Hard-of-Hearing participant.

Term Beginning - Ending Dates * Please enter starting & ending dates and days of the week if applicable.

Campus Name

Campus Street Address

City

State

Zip Code

Campus Phone Number

Is the Requester also the on-site contact person? * YesNo

Requester Phone Number on Day of Event (if different from regular phone number).

Onsite Contact Person

Contact Phone Number (if different than location phone number)

Deaf Participant(s)

Type of Interpreting (if known)

Is the Deaf/Hard-of-Hearing participant a student or the instructor? * StudentInstructor

Class Information

Class Name *

Class Days

Beginning Time - Ending Time *

Class Location Please include room number and building name.

Instructor

Add more classes (each click will add one more class)

Remarks - Please include any additional information about the assignment here. Make sure to include any important information about parking or special instructions for building entry.

Please upload any files that will help the interpreter to prepare for the event. We will forward these files to the interpreter for you.

Assignment Details - Event for Established Client

Date(s) of Assignment * Please enter starting & ending dates and days of the week if applicable.

Beginning Time - Ending Time *

Event Description *

Hearing Participant(s)

Deaf/Hard-of-Hearing Participant(s)

Type of Interpreting (if known)

Assignment Location Please include building name and room number.

Assignment Street Address

City

State

Zip Code

Location Phone Number

Is the Requester also the on-site contact person? * YesNo

Requester Phone Number on Day of Event (if different from regular phone number).

Onsite Contact Person

Contact Phone Number (if different than location phone number)

Remarks - Please include any additional information about the assignment here. Make sure to include any important information about parking or special instructions for building entry.

Please upload any files that will help the interpreter to prepare for the event. We will forward these files to the interpreter for you.

Assignment Details - Classes for Established Client

Unless class schedules are identical, please complete one form for each Deaf/Hard-of-Hearing participant.

Term Beginning - Ending Dates * Please enter starting & ending dates and days of the week if applicable.

Campus Name

Campus Street Address

City

State

Zip Code

Campus Phone Number

Is the Requester also the on-site contact person? * YesNo

Requester Phone Number on Day of Event (if different from regular phone number).

Onsite Contact Person

Contact Phone Number (if different than location phone number)

Deaf Participant(s)

Type of Interpreting (if known)

Is the Deaf/Hard-of-Hearing participant a student or the instructor? * StudentInstructor

Class Information

Class Name *

Class Days

Beginning Time - Ending Time *

Class Location Please include building name and room number.

Instructor

Add more classes (each click will add one more class)

Remarks - Please include any additional information about the assignment here. Make sure to include any important information about parking or special instructions for building entry.

Please upload any files that will help the interpreter to prepare for the event. We will forward these files to the interpreter for you.

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