The information requested below will be emailed directly to our scheduling staff. We will provide confirmation to you via email. If this is an immediate request/need, please call us after submitting this form to make sure it is received. Our office telephone number is (904) 207-0290.
Interpreter Request
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indicates required fields
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Assignment Date:
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Assignment Start Time (include am/pm):
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Expected End Time (include am/pm):
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Deaf Consumer's Name / ID:
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Nature of the Assignment (Legal, counseling, etc.):
Legal: Courtroom
Legal: Attorney/Client Meeting
Legal: Deposition
Medical Appointment
Hospital Visit/Appointment
Counseling Session
Deaf Employee at Work (staff meeting, training, etc.)
General Meeting
Large Conference
DCF Interview/Meeting
Intake
Social Security Intake/Review
Workshop/Training
VR Appointment
Other (Please enter as special instructions below)
Case Number (If there is one):
If in court, type of Proceeding/Event:
N/A
Arraignment
Case Management Hearing
Dependency Hearing
Disposition Hearing
Docket Call
First Appearance
Injunction Hearing
Jury Selection / Service
Pre-Trial Hearing
Shelter Hearing
Traffic Infraction Hearing
Trial
Other (Please enter as special instructions below)
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Language Mode:
American Sign Language
Signed English
Tactile (Deaf-Blind)
Close Vision
Oral (non-signing)
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Assignment Location (name):
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Assignment Address:
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Name of the Requester:
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Requester's Email Address:
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Requester's Telephone Number:
Onsite Contact Person (if not the requester):
Onsite Telephone Number (if not the requester):
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Special Instructions / Assignment Details:
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Has this company worked with us before?:
Yes
No (then please complete the next item)
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Company to Invoice:
Send Invoice to: (address)(if you're new to us):