Name
*
First Name
Last Name
UC ID (M#):
*
E-mail
*
Semester requesting services:
*
Spring 2025
Summer 2025
I am:
*
requesting services
cancelling services
Course Name:
*
Course Number:
*
Section Number:
*
ASL/English interpreting service(s) requesting/cancelling (check all that apply):
*
ASL/English Interpreters (on-site or remote)
ASL/English Video Interpretation of Pre-Recorded Videos (e.g. recorded class lecture for online class)
I do not need this service
Speech-to-text service requesting/cancelling (select only one):
*
Meaning-for-Meaning Transcript Only
Live Captions and Transcript (viewable on device of choice)
I do not need this service
Add a 2nd class?
*
Yes
No
Request 2
I am:
*
requesting services
cancelling services
Course Name:
*
Course Number:
*
Section Number:
*
ASL/English interpreting service(s) requesting/cancelling (check all that apply):
*
ASL/English Interpreters (on-site or remote)
ASL/English Video Interpretation of Pre-Recorded Videos (e.g. recorded class lecture for online class)
I do not need this service
Speech-to-text service requesting/cancelling (select only one):
*
Meaning-for-Meaning Transcript Only
Live Captions and Transcript (viewable on device of choice)
I do not need this service
Add a 3rd class?
*
Yes
No
Request 3
I am:
*
requesting services
cancelling services
Course Name:
*
Course Number:
*
Section Number:
*
ASL/English interpreting service(s) requesting/cancelling (check all that apply):
*
ASL/English Interpreters (on-site or remote)
ASL/English Video Interpretation of Pre-Recorded Videos (e.g. recorded class lecture for online class)
I do not need this service
Speech-to-text service requesting/cancelling (select only one):
*
Meaning-for-Meaning Transcript Only
Live Captions and Transcript (viewable on device of choice)
I do not need this service
Add a 4th class?
*
Yes
No
Request 4
I am:
*
requesting services
cancelling services
Course Name:
*
Course Number:
*
Section Number:
*
ASL/English interpreting service(s) requesting/cancelling (check all that apply):
*
ASL/English Interpreters (on-site or remote)
ASL/English Video Interpretation of Pre-Recorded Videos (e.g. recorded class lecture for online class)
I do not need this service
Speech-to-text service requesting/cancelling (select only one):
*
Meaning-for-Meaning Transcript Only
Live Captions and Transcript (viewable on device of choice)
I do not need this service
Add a 5th class?
*
Yes
No
Request 5
I am:
*
requesting services
cancelling services
Course Name:
*
Course Number:
*
Section Number:
*
ASL/English interpreting service(s) requesting/cancelling (check all that apply):
*
ASL/English Interpreters (on-site or remote)
ASL/English Video Interpretation of Pre-Recorded Videos (e.g. recorded class lecture for online class)
I do not need this service
Speech-to-text service requesting/cancelling (select only one):
*
Meaning-for-Meaning Transcript Only
Live Captions and Transcript (viewable on device of choice)
I do not need this service
Add a 6th class?
*
Yes
No
Request 6
I am:
*
requesting services
cancelling services
Course Name:
*
Course Number:
*
Section Number:
*
ASL/English interpreting service(s) requesting/cancelling (check all that apply):
*
ASL/English Interpreters (on-site or remote)
ASL/English Video Interpretation of Pre-Recorded Videos (e.g. recorded class lecture for online class)
I do not need this service
Speech-to-text service requesting/cancelling (select only one):
*
Meaning-for-Meaning Transcript Only
Live Captions and Transcript (viewable on device of choice)
I do not need this service
Add a 7th class?
*
Yes
No
Request 7
I am:
*
requesting services
cancelling services
Course Name:
*
Course Number:
*
Section Number:
*
ASL/English interpreting service(s) requesting/cancelling (check all that apply):
*
ASL/English Interpreters (on-site or remote)
ASL/English Video Interpretation of Pre-Recorded Videos (e.g. recorded class lecture for online class)
I do not need this service
Speech-to-text service requesting/cancelling (select only one):
*
Meaning-for-Meaning Transcript Only
Live Captions and Transcript (viewable on device of choice)
I do not need this service
Add an 8th class?
*
Yes
No
Request 8
I am:
*
requesting services
cancelling services
Course Name:
*
Course Number:
*
Section Number:
*
ASL/English interpreting service(s) requesting/cancelling (check all that apply):
*
ASL/English Interpreters (on-site or remote)
ASL/English Video Interpretation of Pre-Recorded Videos (e.g. recorded class lecture for online class)
I do not need this service
Speech-to-text service requesting/cancelling (select only one):
*
Meaning-for-Meaning Transcript Only
Live Captions and Transcript (viewable on device of choice)
I do not need this service
Add a 9th class?
*
Yes
No
Request 9
I am:
*
requesting services
cancelling services
Course Name:
*
Course Number:
*
Section Number:
*
ASL/English interpreting service(s) requesting/cancelling (check all that apply):
*
ASL/English Interpreters (on-site or remote)
ASL/English Video Interpretation of Pre-Recorded Videos (e.g. recorded class lecture for online class)
I do not need this service
Speech-to-text service requesting/cancelling (select only one):
*
Meaning-for-Meaning Transcript Only
Live Captions and Transcript (viewable on device of choice)
I do not need this service
Add a 10th class?
*
Yes
No
Request 10
I am:
*
requesting services
cancelling services
Course Name:
*
Course Number:
*
Section Number:
*
ASL/English interpreting service(s) requesting/cancelling (check all that apply):
*
ASL/English Interpreters (on-site or remote)
ASL/English Video Interpretation of Pre-Recorded Videos (e.g. recorded class lecture for online class)
I do not need this service
Speech-to-text service requesting/cancelling (select only one):
*
Meaning-for-Meaning Transcript Only
Live Captions and Transcript (viewable on device of choice)
I do not need this service
Additional comments:
Submit Form
Should be Empty: