Arranging Sign Language Interpretin
g
Services
NOTE: This form is NOT for HR/personnel related activities. For such activities, contact the HR Manager. City
staff may use this form to arrange interpreting services for persons who are Deaf, hard of hearing or deaf-blind who
require sign language interpreting or transliterating, deaf-blind interpreting and/or oral transliteration, and wish to
attend City meetings or events or to participate in other City programs and services. These services are not intended
to cover specialized programs, activities or services designed to target and serve a population of the
community. City departments and agencies that host or create dedicated programs are expected to ensure that
their program budgets include the costs of interpretation services.
Step 1: REQUEST FUNDING *Request date______________________
(Dept. Use Only)
Date of service_______________________
Start Time: ________ End Time: ________
Name of event or meeting:________________________________ City Sponsored? Y N
Event / Meeting Location: __________________________________________________________
Describe the meeting / event below or attach meeting agenda / event flyer:
___________________________________________________________
Site Contact_____________________________ Dept.___________________________________
Email __________________________________Tel.____________________________________
Customer(s) for whom interpreting will be provided:_____________________________________
Preferred Interpreter (not guaranteed): ________________________________________________
* Cancellation notice must be sent to ADA at least 72 hours prior to date of service to avoid fees
charged to requesting department. ADA must approve funding prior to provision of services.
Funding requests for sign language interpreters must be received by ADA at least 5 business days
prior to date of meeting/event.
EMAIL OR FAX TO:
ADA Programs, ATTN: Hoang Banh, hbanh@oaklandca.gov
Tel:
510-238-5219 / FAX: 238-3304
Step 2: APPROVAL (For ADA use only) _________________________________
Signature date
Funding APPROVED for an amount not to exceed $______________________________
Funding DENIED. Notes: ____________________________________________
Step 3: ARRANGE SERVICES—Department representative should make arrangements at
least 3 business days prior to date of service.
Bay Area Communications Access (BACA) Purple Communications
415-356-0405 1-800-900-9478 ext. 1153
bacareq@bacainterp.com purpleoakland@purple.us
Step 4: SUBMIT INVOICE for payment. (Service provider may invoice ADA Programs
directly: ADA Programs, One Frank Ogawa Plaza, 11th Floor, Oakland, CA 94612.)
SIGN LANGUAGE INTERPRETING REQUEST FORM
ADA Programs Updated 10/2018
