UNCP INTERPRETER/TRANSLITERATOR REQUEST FORM

If you need an interpreter/transliterator for a UNCP sponsored activity, fill out the form below and return it to the Accessibility Resource Center office two weeks in advance. You will then receive the bottom portion of this form back when an interpreter/transliterator has been scheduled for you.

Full Name:                                                Today's Date:

Email:                                           Phone/TTY Number:

Sign Prefereneces(Please Cirlce One):
ASL  PSE   MCE  CUED   TACTILE

Events/Activities?

Location?

Date/s:                                         Day/s:

Starting Time:                                         Ending Time:

Additional Information:

Signature:______________________________________________

DO NOT WRITE BELOW THIS LINE

---------------------------------------------------------------------------------------

OFFICE USE ONLY

Interpreter:

Client:                                        Event/Actvities:

Date's & Times:

Location:

ARC Signature:

Special Arrangments: