CCS District Interpreter Request For           American Sign Language  
Reservations submitted with less than 14 days' notice can not be guaranteed.
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REQUESTER INFORMATION 
Name of person requesting interpreter: *
Phone number of requester: *
Email address of requester: *
EVENT DETAILS
Name of deaf consumer: *
Consumer is: *
Date of event: *
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DD
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Event start time: *
Time
:
Event end time: *
Time
:
Event location: *
Location address: *
Meeting location: *
Type of event: *
If other, please provide details:
CONTACT INFORMATION
Is the contact person for the event the same as the requester:


 *
If no, please complete the following:
Name of contact the day of event:
Contact phone number:
CONFIRMATION INFORMATION
Should interpreter confirmation be sent to the same person as event requester: *
If no, please complete the following:
Name of person to receive confirmation:
E-mail address:
Phone number:
Terms and conditions:
By clicking this box, I understand that I am requesting an American Sign Language Interpreter.  I agree to contact 614-365-5977 to make any changes, including cancellation.  Please note after an event is scheduled and cancelled with less than 24 hours' notice, we are obligated to pay for the reservation. *
Required
Thank you for your request.
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