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Office of Accessibility
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This version is from 2003-2005. An updated version is in progress.
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* these fields must be completed
*
Type of Request:
Choose...
One time special request
Recurring Event
Cancellation
*
Requestor´s Name:
Phone Type
Voice
VP
TTY
*
Requestors Phone Number:
*
Requestors Email:
Preferred Method of Contact
Please
Email me confirmation of scheduled interpreter
Please call with confirmation of scheduled interpreter
*
Date of Assignment:
Online requests need to be placed at least two full business days before the date of the assignment.
Duration of Assignment:
Start Time:
End Time:
Recurrence
No
Yes
Recurrence Section
Describe any special circumstances for visit?:
Use this area for in-depth explanation
Recurrence Pattern
Daily
Everyday
Every weekday
Weekly
Every
Select...
1
2
3
4
week(s) on
Mon
Tues
Wed
Thu
Fri
Monthly
Day
of every
month(s)
or...
The
Select...
first
second
third
fourth
fifth
Select...
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
of every
Select...
1
2
3
4
5
6
7
8
9
10
11
12
month(s)
Start Date:
End Date
No end date
End after
occurrences
End by this date
Service Being Requested
Sign language interpreter
Oral interpreter
Tactile interpreter
Speech-to-Text
Other
Specify:
Event title:
UT Campus:
Main Campus
Health Science Campus
Scott Park Campus
Room Number:
Event Location (Off Campus Only):
Event Description:
Known Deaf or Hard of Hearing Attendees
No
Yes
Enter Names:
Site Contact Person:
Will any portion of the event be scripted?
No
Yes
Will any audio visual materials be presented?
No
Yes
If you see this, leave this form field totally blank!
Page updated: July 29, 2008
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