I request an interpreter or transcriber for the following classes:

An interpreter or transcriber is needed for the following special event:

I understand that it is my responsibility to:

• Notify the Coordinator of Deaf and Hard of Hearing Access Services of class or schedule changes.
• Notify DSS Office 24 hours in advance if I will be absent from class.
• Notify Coordinator of Deaf and Hard of Hearing Access Services if my assigned interpreter is unable to meet my language needs.
• Request services 3 days in advance. Less notice may mean services are not available.

Sending this form indicates that you understand the above responsibilities.