Court Request Form - InterpreterRequests

Court Sign Language Interpreter/CART Request Form
* For Pre-Disposition Services Only *
Please fill completely. Where an "*" is shown, the information is required.
THIS FORM IS FOR AUTHORIZED USE ONLY. (COURT STAFF, COURT-APPOINTED ATTORNEYS, ETC.)
Consumers seeking accommodations must contact the Clerk of the Court where the proceeding will be held.

Communication Services needed:

Other communication services needed:

Requestor First Name: *

Requestor Last Name: *

Requestor Phone: *

Requestor Email: *

Additional emails or points of contact:

Name of Court Requesting Service: *

Court Address:

Courtroom #:

Assignment Date(s): *

Please enter the date(s) an interpreter is needed. Click the Save button to ensure your changes are stored.

Comments about the scheduling of the assignment:

Is this assignment taking place at the court address?

Location Description:

Assignment Street Address 1:

Assignment Street Address 2:

Assignment Zipcode:

Assignment City:

If no onsite service provider is available, can this assignment be covered remotely? *

(The court must provide the web meeting link (e.g. Webex) and have the capability to provide adequate audio and video access via digital device or courtroom equipment.)

Is this assignment scheduled to take place virtually?

Case Type: *

Case Number(s): *

Description of Charge(s)/Nature of Case: *

Type of Assignment/Proceeding (select all that apply): *

Other PRE-Disposition needs:

Is there a court-appointed attorney for the Deaf individual(s)? *

(VDDHH does not coordinate interpreter services for privately retained attorneys. Please relay this information to any involved privately retained attorney so they are aware that they will need to set up accommodations for any interactions they have with their client.)

Will an interpreter be needed at the defense table for any privileged communication between the court-appointed attorney and the Deaf individual(s)? *

(If unknown, please contact the attorney.)

Participants: *

Please enter the name of the person requiring accommodation and any other relevant parties including court-appointed attorneys, witnesses, etc. and key hearing participants, if known. Click the Save button to ensure your changes are stored.

Other communication needs:

ADDITIONAL INFO/BACKGROUND/NOTES

How many interpreters needed? (If known based on case history)

Background information or notes that will assist interpreter in preparing for this case:

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