Philadelphia School District ASL Request Form - Deaf-Hearing Communication Centre, Inc.

DHCC- Philadelphia School District ASL Request Form

This Interpreter Request Form is ONLY for Philadelphia School District Customer Use.

Requester Contact Information
Translation and Interpretation Services Requester*
First Last
A team member of the Philadelphia School District Translation and Interpretation Services must provide name, contact number & email
Translation and Interpretation Services Email:*
Translation and Interpretation Services Phone Number*
Contact Details
Contact For Day of Services Name:*
First Last
Contact For Day of Services Phone:*
Contact For Day of Services Email:*
Service Request Details
Type Of Event*
Date of Requested Services*
MM slash DD slash YYYY
Start Time*

: Hours

Minutes

AM/PM
End Time*

: Hours

Minutes

AM/PM
Location Type*
Link for Remote Services:*

If you have a Zoom or Google Meet link for the meeting, please provide the link here or inform us if you plan to send it later to ird@dhcc.org.
School or Building Name :*
Exact Service Location Address*
Street Address Address Line 2 City State ZIP Code
Additional Info:
Email IRD@dhcc.org that may help the interpreter to be better prepared
Who will be attending the services requested?*
Please provide a list of key individuals, including their names and titles. :
Consumer Details
Deaf/Hard-of-Hearing Client Name*
First Last
Name of Individual needing interpretation services
Consumer relation to School District*
Please specify the consumer’s relationship to the district: student, parent/guardian, staff, or other.
If you selected "Other," please specify
Names of Preferred Interpreter, if requested:
Phone
This field is for validation purposes and should be left unchanged.

DHCC- Philadelphia School District ASL Request Form

Requester Contact Information

Contact Details

Service Request Details

Consumer Details

Shortcut Links

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