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Minnesota Interpreter Request
Please fill out the form below.
Billing Company/Information:
Billing Street Address:
Billing City:
Billing ZIP:
Billing Attention to:
Billing Phone Number:
Date You Require an Interpreter:
Calendar
Start Time:
Finish Time:
Location Name:
Room/Building:
Street Address:
City:
State:
ZIP:
On-Site Contact Person:
On-Site Phone #:
Requesters Name:
Requesters Phone:
Requesters Email:
Deaf Person(s):
Deaf Person:
Client/Patient
Family
Employee
Presenter
Describe the appointment in detail:
Will there be technical jargon involved:
Yes
No
Does it involve anyone who is incarcerated:
Yes
No
Terminal illness involved:
Yes
No
Pregnancy termination:
Yes
No
Mental health issues:
Yes
No
Job termination:
Yes
No
Legal situation:
Yes
No
Is blood involved:
Yes
No
Potential Violence or Offensive Behavior:
Yes
No
Highly personal or emotionally charged:
Yes
No
Will you be using any overheads films or videos:
Yes
No
Are the films or videos captioned:
Yes
No
Are there printouts/handouts available:
Yes
No
Is this for Remote Interpreting:
Yes
No
Interpreter Gender Preference:
Male
Female
Requested Interpreter:
* required
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