This request form does not guarantee an
interpreter can be provided. It must be filled out completely and
submitted at least 72 hours prior to an assignment in order
for your application to be processed. The earlier you submit the
request, the better the chances are of securing an interpreter.
Full Name: (required)
Cell Number (text): (required)
Describe the course or event: (required)
Contact Person's Phone/Email:
What other information is helpful
for the Interpreter Coordinator to know in assigning an interpreter(s)?
By submitting this form, I acknowledge that I have read and understand the above, and know this request MUST be
approved by Student Disability Services upon submission.
Student Disability Services | 335 West Hall | MS 45007 | Lubbock, TX 79409-5007 | P 806-742-2405 | F 806-742-4837
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