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Services
Event Access Request Form
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*
" indicates required fields
Requestor Information
New to DSU? No problem. Fill out basic contact information, select your needed service and time. Please check your inbox for a confirmation email to ensure your request was successfully submitted. We’ll get back to you same business day and help fill your requested needs!
Name of Company or Organization
*
Have you used our services before?
*
Yes
No
Requester Name
*
First
Last
Requester Phone
*
Please list a phone number with extension where you can be reached directly if quick access or clarification is needed.
Extension
Billing Location
*
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
Requester Email
*
Enter Email
Confirm Email
All communication regarding this request will be sent to this email.
Appointment Details
Type of Services Requested
*
Select
Video Remote Interpreting
On-site Interpreting
Remote CART
If on-site interpreting services are not available, are video remote interpreting services an alternative option?
*
Select
Yes
No
Would you like to provide a videoconferencing link?
DSU will provide a videoconferencing link for all video remote interpreting requests. If you have an existing link you prefer to use, please paste it above.
Name of Deaf Client
*
Is the Deaf Client receiving services in any of the following states?
*
Select
Alabama
Arizona
Massachusetts
Michigan
Missouri
Oregon
Wisconsin
North Carolina
None of the above
Date of Appointment
*
MM slash DD slash YYYY
To avoid the cancellation policy, including changes to the date or time, please provide at least 2 business days’ notice.
Start Time Services Needed
*
Hours
:
Minutes
AM
PM
AM/PM
End Time Services Needed
*
Hours
:
Minutes
AM
PM
AM/PM
Frequency of Appointment
*
Is this a recurring appointment with additional dates and times?
Select
Yes
No
Describe the Frequency of this Request
Please list additional dates and times.
Timezone
*
Select
Eastern Time
Central Time
Mountain Time
Arizona Time
Pacific Time
Alaska Time
Hawaii Time
Location Name
*
Exact Address of Appointment
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Department, Building, Suite or Floor Number
Additional Details
Type of Appointment/Meeting/Event
*
Additional Request Details
Will this Meeting be Recorded?
*
Select
Yes
No
Additional Location Information (security, parking, etc.)
Other Attendees and Their Role(s)
PO or Routing Code Number
If Requested, Name of Preferred Interpreter
If Requested, Name of Preferred Captioner
Relevant Materials
Max. file size: 128 MB.
Please attach relevant agendas, handouts, presentation slides, case files, etc.
How did you hear about us?
*
Select
Google
Other Search Engine
LinkedIn
Facebook
Accessibility.com
Other Online Directory
Referral
Other
Please Describe
*
CAPTCHA
Please check your inbox for a confirmation email to ensure your request was successfully submitted.