Aging and Long-Term Support Administration

Request for Sign Language Interpreter

1/28/2022 4:33:14 PM
Required Fields are in bold

Purchaser Information

Purchaser information refers to you, the individual making this request. It allows the Contractor to follow up with you as needed.
First Name   Last Name  
Phone  
Email    
If you have not established an account with ODHH and/or contractor previously, or have not used the interpreting service in the past, please take the time to providing us information about your organization.  Your entity is responsible for covering the interpreting cost of Sign Language Interpreters and Agency Booking Fees. Create an account 

Account Name (Agency/Unit/Organization)

Appointment Information


Appointment Date
RadDatePicker
RadDatePicker
Open the calendar popup.
 
Appointment Time Start Time
End Time
Appointment Setting
Setting
Appointment Note Please describe the appointment: For example: A Deaf child with hearing parents meeting for general checkup. A client is a DeafBlind adult coming in for a follow up appointment. More information is better.

Appointment Location

Provide a detailed description of the service location. This helps an interpreter to find the location successfully. Due to COVID, many appointments are now taking place through a Virtual Connection. Please add your physical location and the meeting’s Virtual information. If there is no virtual information, the Interpreter will show up at the physical location.
Location  
Contact (If other than requestor) Phone  (If other than requestor)
Email (If other than requestor)   Text
Address  
Building
 Floor
 Room
City State
Postal Code
Virtual Meeting
Virtual Meeting/Platform
Public
Mixed Group
Direction & Parking Note

Consumer Information

Provide information about the consumer who needs access. This includes preferred interpreters if any. 
First Name: Last Name:
Deaf Participant/Party
(other than client/consumer name)
Gender
Date of Birth (mm/dd/yyyy)
Hearing Identity Hearing Identity
Specific Interpreter Requested
You must select a contractor from the list below: Please note, not all contractors are statewide. If you need information about each Contractor, please go to ODHH's website.

Interpreting Provider:

If you have any comments you want to relay to our contractors and/or interpreters, please enter them below.