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Student Request for an Interpreter

If interpreting services are needed for any college-related events (i.e., instructor meetings, study sessions, tutoring sessions, etc.) other than the regular class schedule, contact Student Counseling and Disability Services and submit an Interpreter Request Form at least 24 hours in advance.

 

Student Name: ___________________________ LA Delta ID #:  ________________

On what days is the communication facilitator needed? ________________________

____________________________________________________________________

What is the event? _____________________________________________________

____________________________________________________________________

Time event begins: ________________Time event scheduled to end: ____________

Location: ____________________________________________________________

Do you have a preference for an interpreter?  If so, please list your preferences in order.

_____________________________________________________________________

FOR OFFICE USE ONLY      Date request received: ________________________

INTERPRETER CONTACT: