Sign Language Interpreter Request Form

Sign Language Interpreter Request Form


Introduction & Instruction

The School District of Philadelphia is able to provide Sign Language Interpreting Service for students, parents (guardians), employees and community members for such activities as report card conferences, IEP meetings, extra-curricular school functions, SRC public meetings, and the like.

This Request Form is not to be submitted until you have a specific date, place and time for the event**. Absent an emergency situation, all written requests for Sign Language Interpreting Service should be made at least two (2) weeks prior to the meeting/event in order to assure the availability of a qualified sign interpreter.

Following completion of this Request Form, you may email the completed form as an attachment addressed to Adam Buck at signlanguagerequest@philasd.org, or complete the online request form below.


Notes:
* To contact an individual who is deaf or hard of hearing via telephone, you may use the services of the Pennsylvania Relay Center at 1-800-654-5988. The Relay Center will act as an intermediary for the deaf person using a communication device while the caller uses a standard telephone.

** Please report all schedule changes promptly to signlanguagerequest@philasd.org

Name *
Address *
Phone *
From *
Name of the Deaf/Hard of Hearing Person *
Relationship to District Student
Parent/Guardian
Staff
Visitor
*
Type of Meeting *
Date of Meeting *
* For example: MM-DD-YYYY
Time of Meeting *
Location of Meeting *
Location Street Address *
Location Zip Code *
Location Phone *
Room Number/Location in the Building *
For School Site Meetings, please complete this additional information:
Child’s Name
Age
Grade
Will the child attend this meeting? Yes   No
School Contact Person's Name/Title
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