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Language Services Request Form

If you or your program need interpreter services for upcoming classes, events, or client interactions, please complete this form with as much detail as possible. Your request will be forwarded to Amanda Paradis, Americans with Disabilities Act (ADA) Coordinator, University of Maine Office of Equal Opportunity, who will arrange the appropriate interpreter services to support your needs and those of your audience.

Requestor Name

Requestor Email Address

Extension Program Area/Department

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Request for

Interpretation (oral) including American Sign LanguageTranslation (written)Braille or Large FrontOther

Other:

Requested Mode of Interpretation (oral/ASL)

OnsiteVirtual (Zoom, Google Meet, or other third-party platform)Phone

Is this request for a single session or for a series of sessions?

One-time event, class, program, or sessionSeries of classes, programs, or sessions

Dates & Times (Start Time & End Time)

Please provide all dates and times when interpretation services will be needed

Location (name of location, street address, and any additional directions for interpreters).

Specify the number of interpreters needed, along with the required languages.

Name of person(s) needing services (include contact information during day of event if appropriate).

Description of Class, Event, Program, or Session

To better accommodate interpreter requests, please provide a description of the class, event, program, or session that you plan to offer.

Please attach any other relevant information that the interpreter can review to better prepare for the assignment, such as agendas, advertisements, links, flyers, brochures, handouts, lesson plans, or curriculum materials.

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Contact Information Prior to Event, Class, or Program

Name

Phone Number

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Contact Information DAY OF/DURING Event, Class, or Program

Name

Phone Number

Contact Information