Request for Pinellas County Schools Sign Language Interpreter
This form is only used for PCS Students and Deaf adult family members.
Requests should be made a minimum of 72 hours ahead of time. Please note that cancellation must be 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
Meeting Details
Request for Service
*
Please Select
Initial Request for Service
Cancel Request
Reschedule - Update the date and time below.
Location where the interpreter is needed:
*
Please do not abbreviate, as many schools have similar acronyms.
Address of School or Location for interpreter
*
Address of Assignment. (see below in the flow of form)
Phone number for Point of Contact for Interpreter
*
Please enter a valid phone number.
Format: (000) 000-0000.
Service Category
*
Please Select
Deaf Adult (ADA)
PCS Student
Name of Individual(s) Requiring Services (K-12)
*
Name of Individual(s) Requiring Services (Adult)
*
First Name
Last Name
Phone Number for Individual Requiring Services (Adult)
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email for Individual Requiring Service (Adult)
*
example@example.com
Reason for Request
*
Frequency of Meeting
*
Please Select
One Time Occurrence
Reoccurring (Examples: Class, PTA Meeting)
Date of Event
*
Start and End Times
*
Should be the same as the time selected above Start Minutes
AM
PM
AM/PM Option
Until
until
End Hour End Minutes End Minutes (MIN. OF 2 HOURS)
AM
PM
AM/PM Option
Total 0.0
Explain the cadence of the reoccurring meeting.
Examples:
The first Monday of every month.
Every other Tuesday.
Every Monday, Wednesday, Friday.
Daily
Cadence for Reoccurrence
*
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
Special instructions for interpreter upon arrival or add schedule
Person Submitting This Request
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 at the Event or Meeting
This individual is the day of contact!
Point of Contact Name (Day of)
First Name
Last Name
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.
Submit
Specialized Services Processing
Office Use Only
Office Use Only
Processing
Number of Interpreter Assigned
One
Two
Provider
Please Select
PCS Staff
AQI Provider
SignTalk Provider
PCS Staff and Outside Provider
Interpreter 1
PCS Interpreter 1 Email
example@pcsb.org
Interpreter 2
PCS Interpreter 2 Person Email
example@pcsb.org
Should be Empty: