STUDENT INTERPRETER/REAL TIME CAPTIONING

SERVICES REQUEST FORM

Today’s Date ____________ Name _______________________________

Phone number where you can be reached: ____________________________

Date/Dates Service is needed: __________________________

Check type of Service:

Interpreter_______

Real Time captioning________

Beginning Time: ________________ Ending Time: __________________

Type of Activity (Test, meeting, lecture, etc): _________________________________________________

__________________________________________________

Give the full address of the site where the interpreter/captionist will need to provide services:

__________________________________________________________

Please call (402) 472-3787 for questions .

Interpreter Requests email:

Barb Woodhead, Assitant Director / Coordinator

Bwoodhead1@unl.edu