Service Request Form

Persons requesting interpreting services at least 24 hours in advance may complete the service request below. Requests may also be submitted by phone: (979) 268-1222.

(For a detailed breakdown of our rates, please refer to our Rate Sheet.)

For requests by phone, please have the following information ready:

Your name and telephone number.
Actual consumers involved, both hearing and Deaf (including language requirements, if known).
A description of the event.
Contact person and telephone number on-site.
Time and duration of the assignment.
Location, including physical address, parking instructions and room numbers.

General Information

Services are available 24 hours a day.

INTAKE: Sign Language Interpreting Services will evaluate client needs based on information provided by the customer, considering Americans with Disabilities Act requirements.
PLACEMENT: When a request is made for a specific interpreter, S.L.I.S. assigns the individual provider if they are qualified and available. Otherwise, we will assign the closest, "qualified" and available service provider.
FOLLOW-UP: S.L.I.S. allows all involved parties to provide feedback concerning any assignment. Feedback is documented and reviewed for quality assurance purposes.


* Required fields are denoted by an asterisk
Customer Information
Important: In this section, please enter the person or organization requesting the service. Deaf consumer(s) will be entered in Step 2.
First Name
* Last Name	Please enter at least one of these fields
* Organization
* Phone Number
* Email Address	Please enter a valid email address, that is in the form "user@domain.com"
Customer Billing Address
	The fields below are used exclusively for billing purposes. You will enter the assignment location in Step 3.
* Street Address	Please include suite or apartment number
* City, State, Zip

Assignment Description
* Assignment Type: Select One	Medical Mental Health Legal Business Community Education State Agency Other
* Language Mode: Select One	Oral American Sign Language (ASL) Transliteration Tactile for Deaf/Blind Consumers Transcription Unknown
Event description (Parking requirements, security measures…)	Important: Please include special instructions and any information interpreters may need.
* Contact Person Name	(On site)
Contact Person Phone
Deaf Consumer(s) One Customer name per line If unknown, enter "Unknown"

Assignment Date and Time
* Date
* Starting Time	:
* Expected Duration	Important: Any assignment longer than 2 hours may require more than one interpreter, which would affect the cost of the assignment.
Recurrence Will the assignment repeat itself over time? Show me an example	Examples of recurring assignments: • Tues/Thurs from 2:35-3:50 • Every 3rd monday of the month at 5 PM Important: Interpreter(s) may not be able to stay past the stated duration of assignment
Assignment Location

* Street Address	Please include suite or apartment number
* City, State, Zip	TXZip code

Submission Agreement
Due to the increased costs of doing business, our hourly rates have increased by $5 on January 1st, 2010. I have read and agree to S.L.I.S. policies and procedures Click the link to view our policies and procedures (opens a new window)

Charles Web Design, Bryan College Station Texas