Interpreting Services Request

Please contact Disability Services (703.993.2474) if you do not receive confirmation of your request within 24 hours. Email Aja Puopolo (apuopolo@gmu.edu) for questions regarding your request and this form.

Interpreting Services Request

Your name*
Your email address*
Your office/department/school*
Department Organization or Budget Code (FUND, ORGN, PROG)*

Enter ‘N/A’ if not applicable. You will be notified if your department will be charged.
Is event sponsor same as your office/department/school?*
Event Sponsor (i.e., Department, School, College, Unit)*
Event Sponsor Department Organization or Budget Code (FUND, ORGN, PROG)*

Enter ‘N/A’ if not applicable. You will be notified if Event Sponsor’s department will be charged.
Event Information
Date of event*
Month
Day
Year
Name of event
Is there a fee charged to participants?*
Fee price*
Type of event*
Please describe event
Start Time

: Hours

Minutes

AM/PM
End Time

: Hours

Minutes

AM/PM
Event Location
Address*
Virtual meeting Link (WebEx, Zoom, etc.), if applicable
Building Name*
Room Number*
On-Site Information
On-Site Event Contact Person's Name*
On-Site Event Contact Person's Phone Number*
On-Site Event Contact Person's Email Address*
Who requires American Sign Language interpretation?*
Student's Name
Visitor's Name
Faculty/Staff Name
Contact number for person requiring American Sign Language interpretation*
Email address for person requiring American Sign Language interpretation*
Information for Interpreter
Is parking validation available for interpreter(s)?*
If meals or refreshments are provided for participant(s), will meals be provided for interpreter(s)?*
Meals provided include (check all that apply)
- Refreshments
- Breakfast
- Lunch
- Dinner
Additional Information
Please provide any additional and important information about the event here. Include relevant links or websites.
Upload any relevant pamphlets, brochures, or flyers about the event.
Drop files here or

Max. file size: 50 MB.

Interpreting Services Request

Interpreting Services Request

Event Information

Event Location

On-Site Information

Information for Interpreter

Additional Information

Contact Disability Services

Student Union Building I (SUB I) - Suite 2500 Phone: 703.993.2474 Fax: 703.993.4306 email: ods@gmu.edu

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