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Interpreter Request Form
JSU Home » Disability Support Services » Interpreter Request Form
JSU Home » Disability Support Services » Interpreter Request Form
* ADA states that all requests must be made in a timely manner.
Therefore, it may not be possible to accommodate last minute requests.
Please fill out a separate form for each of your classes. If you change your schedule you should fill out a new form for the new class and fill out a form canceling the request for the old class.
| Student's Name | |
| Request service for a class Cancel request for a class |
|
| Student's E-mail Address | |
| Phone/TTY | |
| Semester and Year i.e. Fall 2005 |
|
| Course Name and Number i.e. EH 101 |
|
| Course Title i.e. American History |
|
| Instructor's Name | |
| Course Call Number This can be found in the semester catalog. |
|
| Days the class meets i.e. MWF |
|
| Time (start-finish) i.e. 3:00-4:00pm |
|
| Building/Room # i.e. Ayers Hall/230 |
|
| Service Requested | Interpreting Captioning |
|
Please give any additional information here. |
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