Request for Pinellas County Schools Sign Language Interpreter
Meeting Details
Cancellation or Reschedule
Please Select
No Change
Cancel
Reschedule - Update the date and time below.
Name of School or Location
*
Address of School or Location
*
Address of Assignment. (see below in the flow of form)
Location Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Service Category
*
Please Select
ADA (Adult 18+)
K12 (PCS Student)
Frequency of Meeting
*
Please Select
One Time Occurrence
Reoccurring
Explain the cadence of the reoccurring meeting.
*
Date of Event
*
Start and End Times
*
Start Hour Start Minutes
AM
PM
AM/PM Option
Until
until
End Hour End Minutes (MIN. OF 2 HOURS)
AM
PM
AM/PM Option
Total 0.0
Day of the Week
Example: Monday, Tuesday, etc.
Reoccurring Meeting First Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reoccurring Meeting Last Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name of Individual(s) Requiring Services (Adult)
*
First Name
Last Name
Person Requiring Services Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Person Requiring Services Email
*
example@example.com
Name of Individual(s) Requiring Services (K-12)
*
Reason for Request
*
Special instructions for interpreter upon arrival or add schedule
Point of Contact - Me or Someone Else
me (the requester completing this form).
someone other than me, I will provide their information below.
Requester Details
Requester's Name
*
First Name
Last Name
Requester's Job Title
*
Requester's Department
*
Requester's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Requester's Email
*
example@example.com
Point of Contact Details
Point of Contact for Meeting/Event
*
Example: Person who will be at the event who can be contact by the intrepreter.
Point of Contact Title/Role
*
Point of Contact Email
*
example@pcsb.org
Point of Contact Phone Number
Please enter a valid phone number. If the event is outside of regular operating hours, provide an alternative phone number where a person can be reached after hours.
Format: (000) 000-0000.
Requests should be made a minimum of 72 hours ahead of time. Please note that cancellation is requested at least 24 hours in advance, when possible. For assistance, please contact Patricia Davidson, Coordinator of DHH, at 727-793-2732 x2382 or email interpreter@pcsb.org
Specialized Services Processing
Office Use Only
Office Use Only
Processing
Interpreter
Agency
Please Select
PCS
AQI
SignTalk
Submit
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