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Classroom Interpreter/Transcriber Request Form

 

By submitting this I agree to the following:

1. I understand that I must request interpreter/captioning services in writing with specific times and places itemized.
2. I understand that it is my responsibility to inform the LAP office in advance whenever I will be absent so they may contact the interpreter/captionist.
3. I understand that if I miss class three times without prior notification, services may be terminated until I request in writing for them to be reinstated.

Name*Email*Phone*Phone TypeText
Video Phone
Msg
TermFall
Spring
Summer
Year -Select- 2011-2012 2012-2013 2013-2014 2014-2015 2016-2017
Preferred Communication ModeASL
Signed English
Real Time Captioning
Course CRN & Title*Course CRN & TitleCourse CRN & TitleCourse CRN & TitleCourse CRN & TitleComments
For Office Use Only
I agree to the terms of services listed aboveAgree

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