Language
English (US)
Spanish (Latin America)
Intake Form for Interpretation Services
Email
*
example@example.com
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Organization
*
Mission of Organization
*
Annual Operating Budget (approx.)
*
Key Services/Programs Offered
*
% of Clients who are LEP (est)
*
Subject Matter of Interpretation. Please note that the CLA Institute will not provide court interpretations nor medical interpretations between a patient and healthcare worker.
*
Audience and Goal of Translation
*
Simultaneous or Consecutive Interpreting
*
Simultaneous
Consecutive
Number of Individuals needing Interpretation (if more than a 2 person meeting)
*
Interpretation Preference
*
In-person
Phone
Video Conferencing
If in person, location
*
Estimation of minutes that will be spent interpreting
Date and Time of interpretation (please note a 30 minute initial pre-meeting is required for interpreter to meet with all parties)
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Your typed signature indicates that you agree to a translation completed by undergraduate students.
*
Submit
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