Interpreter/Captioner Request Form

Every effort will be made to fill requests received within 48 hours of the time being requested, however availability of service providers is highly unlikely. To improve the chances of service availability, plan ahead and submit your requests in a timely manner.

Contact Information

Student Name
Student ID This is a ten digit number.
Student MyUW Net ID	@wisc.edu
10 Digit Phone Number No parenthesis or dashes.

Service Being Requested

Interpreter
Captioner

Is request academically required (i.e., required as part of a Timetable course you are enrolled in)?

Academically Required
Not Academically Required

Location and Time

Date of Assignment

Month	Day	Year

Start Time

Hour	Minute	AM or PM

End Time

Hour	Minute	AM or PM

Location

Building and Room Number

Description of Request

Please use the comment box below to describe the assignment in detail and explain what the interpreter or captioner is expected to do. Include names of key people and any special circumstances. If you have any written preparation materials (ie, agendas, hand-outs, outlines, etc.) please fax the information to McBurney at (608) 265-2998 or drop it off at the McBurney Main Desk at 1305 Linden Avenue on the first floor.

McBurney

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Interpreter/Captioner Request Form