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Disability Support Serivices
PO Box 1510
Pembroke, NC 28372
Phone/Voice: 910.521.6695
Fax: 910.521.6891
TTY: 910.521.6490
Email: dss@uncp.edu
Location: D.F. Lowry Building, Room 103
Campus Map
UNCP INTERPRETER/TRANSLITERATOR REQUEST FORM
If you need an interpreter/transliterator for a UNCP sponsored activity, fill out the form below and return it to the Disability Support Services office two weeks in advance. You will then receive the bottom portion of this form back when an interpreter/transliterator has been scheduled for you.
Your Name |
Today’s date |
Email: |
Phone/TTY number:
|
Sign preference (please circle one): ASL/PSE/MCE/CUED/TACTILE |
|
Event/activity?
|
|
Location?
|
|
Date/s |
Day/s |
Starting time: |
Ending time: |
Additional Information
|
Signature________________________________________________
DO NOT WRITE BELOW THIS LINE
------------------------------------------------------------------------------------------------------------
OFFICE USE ONLY
Interpreter |
|
Client: |
Event/activity: |
Dates & Times: |
|
Location: |
|
DSS Signature: |
|
Special arrangements:
|
|
Updated: Thursday, June 19, 2008
© The University of North Carolina at Pembroke
PO Box 1510 Pembroke, NC 28372-1510 • 910.521.6000