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DIVISION OF REHABILITATION-EDUCATION SERVICES

OFFICE OF SENSORY AND TESTING ACCOMMODATIONS



INTERPRETER REQUEST AND VERIFICATION FORM



The Interpreter Request and Verification Form (IR/VF) is used to facilitate UIUC

departments/units requesting sign language interpreter services for university activities and

events.



Requests/Verification/Cancellation

When possible, and to increase the probability of obtaining specifically requested services, the

form must be submitted at least two weeks prior to the requested date(s) of service. Submit

requests to: Theresa Rear, Staff Interpreter, 1207 S. Oak Street, MC-574 or by FAX at 333-0248.

Your request with the name of the assigned interpreter will be verified by return FAX. To cancel

services, call the Office of Sensory and Testing Accommodations, 333-4604, no less than 48 hours

prior to the start of the scheduled event. In the event of lesser notification, the event sponsor will be

charged at the identified hourly rate for the minimum number of hours stipulated.



Payment

Interpreter services will be billed to the requesting department/unit by the Division of

Rehabilitation-Education Services via a stores voucher(when applicable). On occasion, it may be

necessary to use an outside agency or contract interpreter. In such cases, payment to the outside

agency/contract interpreter will be made directly by the requesting department/unit to the

agency/contractor. Payment method will appear in the verification section.



Section I – Requests To be completed by UIUC Department/Unit Requesting Services (do not detach)



Department/Unit Name:_________________________________Date:_________________



Billing Address_____________________________________Mail Code________________



Contact Person:____________________Phone:________Email:_________Fax:__________



Name of Event:__________________________Location of Event:_____________________



Date(s) Services Required:_______________Starting Time:________Ending Time:_______



Contact Person (at event):_____________________Phone:__________Email:____________



Description of Event:__________________________________________________________

-------------------------------------------------------------------------------------------------------------------------------------------------------------------------

To be completed by the Division of Rehabilitation-Education Services (do not detach)



Section II - Verification



Name of Interpreter:___________________Hourly Rate:______Minimum Hours:_________



Method of Payment:__________________________Comments:_______________________



__________________________________________________________________________



___________________________Date_______________


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