InterpreterServiceRequestForm-HR Office-6/20/17
PASADENA CITY COLLEGE
OFFICE OF HUMAN RESOURCES-C204
SIGN LANGUAGE INTERPRETING SERVICES REQUEST FORM
Pasadena City College is committed to providing reasonable accommodations for individuals with disabilities. Please use
this form if you desire an accommodation related to deaf or hard of hearing. Please submit the form at least 10 working
days before the event to ensure availability.
NOTE: LifeSigns provider has a 25-hour cancellation policy on appointments of two hours or less and a 49-hour
cancellation policy on appointment lasting longer than two hours.*
Today’s date:
Time:
Employee requesting Service:
Employee’s division:
Employee’s contact number
or email address:
Date Services are requested:
Start time:
End time:
Location/Room number:
Nature of assignment
(meeting, in-service, etc.):
Special Notes/Additional
:
Comments
Approval: Date:
Director, Human Resources
*Please Note Late Cancellation or Noncancellation Policy: For late cancellation or no cancellation notification by the timeline noted
above, services will be billed to the requesting division/department.
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