Live Remote Captioning Request – Disability Services

Live Remote Captioning Services Request

Email Aja Puopolo (apuopolo@gmu.edu) for questions regarding your request and this form.

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

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 or department?*
Event Sponsor (i.e., Department, School, College, Unit)*
Event Sponsor Department Organization or Budget (FUND, ORGN, PROG) Code*

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 Link and Details
Link*
Password*
Call-In 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 live remote captioning?*
Student's Name
Visitor's Name
Faculty/Staff Name
Contact number for person requiring live remote captioning.*
Email address for person requiring live remote captioning.*
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.