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Interpreter Request Form
Requester:
Department Organization:
Email Address:
Phone Number:
Event/Course Title:
Nature of Event:
Lecture
Panel
Meeting
Class
Other
Not Applicable
Requested Day/Date(s):
Start Time:
End Time:
Building & Room Number:
Address: (other than AU Campus):
On-site Contact Person:
On-site Phone Number:
Estimated Number of Participants:
Estimated Number of Primary Speakers:
Name of Speaker(s):
Name of Deaf Person (if known):
Preferred Communication Mode:
ASL
PSE
SEE
Oral
Other
Not Applicable
Additional Information:
By clicking here, I certify that I have completed the Interpreter Request Form to the best of my ability and have reviewed the Interpreter Request Statement.
Interpreter Request Statement The procedure for Interpreter Requests will be the same each semester. If you have questions and would like to speak to someone regarding the Accommodation Letter Request application, please call the Disability Support Services at 202-885-3315 or email at dss@american.edu.
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