Request for American Sign Language Interpreter Form

Request for American Sign Language Interpreter Form
American Sign Language interpreters will be available upon request for Girl Scouts and Girl Scout volunteers at troop meetings, service unit events, or council program events. Please complete this form at least one week prior to the date the interpreter is needed.

If you are requesting reimbursement for an interpreter please choose the option "I am requesting reimbursement for an interpreter," and fill out the follow up questions to complete your request.

If you are requesting an interpreter for a council event that is being hosted by an outside venue that will also be open to the general public (for example, an event at Target Center or the Xcel Energy Center), please connect with that venue first about ADA accommodations before completing this form.
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Are you requesting an American Sign Language interpreter or reimbursement for an interpreter?*

I am requesting an American Sign Language interpreter.I am requesting reimbursement for an interpreter.
What type of event are you requesting an American Sign Language interpreter for? (Select one)*

Troop EventService Unit EventCouncil Program Event
Location where American Sign Language services are requested:*
Event Location Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Event*

MonthDayYear
Start Time*

Hour Minutes

AM/PM Option
End Time*

Hour Minutes

AM/PM Option
Are the interpreter services for a Girl Scout or adult?*

Girl ScoutAdult
Girl Scout and/or Adult Name(s)*
Troop Number*
Service Unit Number*
Use the service unit directory if you're not sure.
Program Grade Level*

DaisyBrownieJuniorCadetteSeniorAmbassador
Please describe activity in detail.*
For example: "Girl Scouts will be sitting at tables doing a craft activity, then having story time."
Is an American Sign Language interpreter needed for regular troop meetings?*

YesNo
Please upload a schedule of meetings (include dates, times, and sites).*

Cancelof
Should be Empty: