Request for a Sign Language Interpreter

* required fields

The purpose of this agreement is to assure that the student named below will receive the services of a qualified sign language interpreter as needed. The student must fill out this form for each class or activity that s/he is requesting an interpreter. The form must be filled out completely and turned into ODS 2 weeks prior to the class or activity.

Student Information
If Applicable
Monday Tuesday Wednesday Thursday Friday Saturday

24 HOUR CANCELLATION NOTICE IS REQUIRED

Declaration
I hereby authorize the Office Disability Services of Barry University to release/receive necessary information deemed relevant to disability accommodation and ODS program eligibility at Barry University.

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