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:__________________________________________________________
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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_______________