ASL Interpreter Request
WLAC Faculty and Staff
The top portion of this form must be filled out completely for the request to be processed and approved.
The request must be submitted five (5) or more days in advance. Please email request form to college
ADA Coordinator Silvia Barajas (barajas2@wlac.edu) and Lead Interpreter Michelle Hernandez:
(interpret@wlac.edu)
Name: ______________________________________________ Date: ___________
Last First
Department: Email: ____________________ Phone: __________________
On Campus Assignment Information
Deaf Fac
ulty/Staff: _____________________________ Location: __________________
Date: _______________ Start Time:__________ ☐AM ☐PM End Time:__________ ☐AM ☐PM
Reason
for Interpreter
☐ F
aculty/Staff Meeting (one on one) ☐ Department Meeting ☐ Student Appointment
☐ Workshop ☐ ASL Class ☐ Student Event
☐ College Event ☐ Voicing ☐ Other
Pr
ovide information that will be helpful in assigning interpreter:
Of
f Campus Assignment Information
Add
ress: _____________________________________________________________
Street City ZIP
Location/Building/Room #: _______________________________________________
Parking Instructions: ____________________________________________________
Special/Other Instructions: _______________________________________________
☐ Approved ☐ Not Approved Date: __________ Signature: ____________________________
ADA Coordinator
click to sign
signature
click to edit
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