Interpreting Request Form

Department of ASL & Interpreter Education
Interpreter Training Program

521 Lancaster Avenue • Wallace 216 • Richmond, KY 40475 • 859-622-4966

Interpreter Request Form

For EKU Sponsored Events Only

1) Requested by:	* Required Fields
* Name:
* Email:
* Phone:
Date Requested:	(mm-dd-yyyy)

2) Event Information:
Event Description:
Event Date:	(mm-dd-yyyy)
Starting Time:	: AM PM
Ending Time:	: AM PM
Event Address:
3) Contact Information:
Contact Person:
Contact Email:
Contact Person Phone:
	Faculty Staff Administration Visitor
4) Other Information:
Deaf Attendees:
Language Preference:	ASL Transliteration
Special Instructions:
	Please enter the validation code in the box: