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 ([email protected]) for questions regarding your request and this form.

Your name*
Your email address*
Your office/department/school*
Department Fund Code*
If applicable, a Journal Voucher will be submitted with the codes provided in order to reconcile the charges for services
Department Organization Code*
If applicable, a Journal Voucher will be submitted with the codes provided in order to reconcile the charges for services
Department Account Number*
If applicable, a Journal Voucher will be submitted with the codes provided in order to reconcile the charges for services
Department Program Code*
If applicable, a Journal Voucher will be submitted with the codes provided in order to reconcile the charges for services
Is event sponsor same as your office/department/school?*
Event Sponsor (i.e., Department, School, College, Unit)*
Event Sponsor Department Budget Code*
Enter ‘N/A’ if not applicable. You will be notified if Event Sponsor’s department will be charged.
Event Sponsor Department Organization Number*
Enter ‘N/A’ if not applicable. You will be notified if Event Sponsor’s department will be charged.
Event Sponsor Department Program Number*
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
Is this a recorded or streamed event? If so, will interpreters appear on screen?*
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.
Max. file size: 50 MB.

Interpreting Services Request

Event Information

Event Location

On-Site Information

Information for Interpreter

Additional Information