Ivy Tech Community College-Central Indiana Campus Event Interpreter Request Form
To request an interpreter for a campus event or activity, students or staff members should complete this form. The DSS office may not be able to secure interpreting services that are requested less than two weeks in advance. If you have any questions, please contact Darin Mitchell in the Disability Support Services Office (NMC 143) at dmitchell94@ivytech.edu or 317-921-4598.
Name of Requestor: *
Your answer
Phone: *
Your answer
Email: *
Your answer
Name of individual requiring interpreting:
Your answer
Name of Event: *
Your answer
Date of event: *
MM
/
DD
/
YYYY
Location (Include building and room #): *
Your answer
Beginning time: *
Time
:
Ending Time: *
Time
:
Billing Information: Dept. PO#
Your answer
Submit
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