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Request for Service Provider

Need to schedule an accessibility provider? Communication Service for the Deaf is here to support you.

CSD recognizes accessibility creates equal opportunity. We created this form to support our external partners with accessibility requests. We will always try to book your preferred providers first and try our best to accommodate your needs.

If you need to make any change to an existing appointment, please email csdaccess@csd.org.

"*" indicates required fields

Requester Contact Information

Is this request for

Name*

First Last

Email*

Enter Email Confirm Email

Phone

Is your phone number a Voice or VideoPhone number?*

Voice

VideoPhone

Other

Personal Billing Information

Your Name Associated with Billing Address*

Your Billing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email address to send billing invoice to:*

Business Billing Information

Name of your Business*

Business/Organization Billing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email address to send billing invoice to:*

Assignment Details

Meeting Location Type*

Virtual

Onsite

Not Sure

Meeting Location Type Unsure Description*

Platform Meeting Link*

Site Name (CSD Main Office, etc)*

Building and Room Number

Site Contact Phone Number*

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Site Contact Phone Number

Onsite Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Onsite Contact Name*

First Last

Onsite Contact Phone Number*

Assignment Description

Participants*

Please list ALL participants.

What is the situation... Is it a Workshop, Meeting, etc.?*

Preferred Service Providers

Do Not Invite Service Providers

We wish to make every effort possible to ensure an ideal and culturally-responsive fit between all consumers and the interpreters assigned to them. Please tell us any specific needs and/or preferences related to interpreters assigned, including but not limited to: gender identity, race or ethnicity, language expertise outside of ASL and English, the need for deaf interpreters, etc.

Service Type*

Interpreter

Captioner

Voiceover

Transcript

Other

Other*

# of Interpreters*

# of Captioners*

Meeting Date*

MM slash DD slash YYYY

Meeting Start Time*

Hours

Minutes

AM/PM

Meeting End Time*

Hours

Minutes

AM/PM

Timezone*

Is this meeting a recurring meeting?*

Yes

How often does this recur?*

Anything you want the interpreters/captioners to know before the job? (This note only goes to the service providers who accept the job)

Last-minute requests cannot be guaranteed, although attempts will always be made to secure accessibility services.

CAPTCHA

Phone

This field is for validation purposes and should be left unchanged.