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October 6th – December 15, 2022. 6:30 PM
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Request an Interpreter

Please provide as much information as possible to avoid coordinating delays.
Your confirmation of request receipt will be emailed within 24 hours/one business day.

IMPORTANT: After submitting your request form, please follow-up immediately with a phone call if your request is for the same day or if your request is made after business hours and needs our attention before the next business day.

If you do not know the answer to a question, place “unknown” in the field and continue filling out the form. We can help you obtain the information once the form has been submitted.

"*" indicates required fields

Requestor

Requestor’s name*

Phone*

Email*

Point of contact

Same as requestor?

Yes; Use requestor info

Point of contact’s name*

Phone*

(reachable at time of event)

Organization

Does your organization have a signed agreement with Interpretek?*

Yes

No / Not Sure

Organization responsible for payment*

PO number

(if required for invoice payment)

Event details

Is this a multi-day event?*

Yes

Date of event*

First day of event*

Last day of event*

Start time*

End time*

Event title

Event description*

All participants

Place any participants that will be interacting with the consumer. It is useful for the interpreter to know ahead of time how many people will be involved.

Name

Interpretation type*

Onsite

VRI (Video Remote Interpreting)

Event location title*

Event location*

Street Address Bldg / Room # City State ZIP Code

Specific instructions for interpreter(s) upon arrival

Is this your first VRI request with Interpretek?*

Yes

Platform of service delivery*

Interpretek’s platform

Zoom, WebEx, etc..

Is prep material available?*

Yes

Consumers

Deaf consumer(s)

Name

Role

Date of Birth

Member ID

Reference ID

Hearing consumer(s)

Name

Role

Date of Birth

Consumer’s language preference(s)

If you do not know, please reach out to the consumer.

ASL

PSE

Signed English

Tactile

ProTactile

Close Vision

Trilingual

Unknown

Third language

Preferred interpreter(s)

(list by name)

Additional information

How did you hear about us?

Regional Office*

If you know a staff member in a specific office select that regional office, if not choose "I’m not sure"

Hidden

Event timezone

Name

This field is for validation purposes and should be left unchanged.