DSS - Interpreter Request Form

Requester:

Department Organization:

Email Address:

Phone Number:

Event/Course Title:

Nature of Event:

Lecture

Panel

Meeting

Class

Other

Not Applicable

Day/Date(s):

Start Time:

End Time:

Building & Room Number:

Address: (other than AU Campus):

On-site Contact Person:

On-site Phone Number:

Estimated Number of Participants:

Estimated Number of Primary Speakers:

Name of Speaker(s):

Name of Deaf Person (if known):

Preferred Communication Mode:

ASL

PSE

SEE

Oral

Other

Not Applicable

By clicking here, I certify that I have completed the Interpreter Request Form to the best of my ability and have reviewed the Interpreter Request Statement.

Interpreter Request Statement The procedure for Interpreter Requests will be the same each semester. If you have questions and would like to speak to someone regarding the Accommodation Letter Request application, please call the Disability Support Services at 202-885-3315 or email at dss@american.edu.

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