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_______________