Interpreter Request Form

Interpreting/Captioning Request Form

The following form is to assist the DPS office in providing sign language interpreters/captioners for individuals who need access to courses, meetings, events or activities throughout Chaffey College.

Requests must be made at least 3 business days prior to the event. Requests submitted with less than 3 days’ notice may not be able to be granted.
**Exceptions for classroom interpreters**

If you need to cancel the interpreter/captioner after a request has been submitted, you must notify DPS via email or phone call within 48 hours in advance of the event. If you have any questions, please feel free to reach out to Jessica Arreguin, DPS Support Generalist/DHH Coordinator at (909)652-6378 or jessica.arreguin@chaffey.edu.

Name*

First Name

Last Name

Student ID#*

Email*

(panther.chaffey.edu email preferred)

Phone

Service being requested (please check only one)*

ASL Interpreting Live Captioning (CART)

START Date/Time of Event*

:

END Date/Time of Event*

:

Type of event*

(example: counseling appointment, tutoring, teacher/student meeting, group project, ect.)

Location of Event*

Rancho Cucamonga Campus Fontana Campus Chino Campus Online (if online, please provide link in the field below)

Other:

(please provide building & room number)

Room Location/Online Link*

Checkbox*

By Checking this box you agree to to the DPS Interpreting/Captioning agreement. After interpreting services have been arranged for you, it is essential that you utilize these services efficiently. Please contact Jessica Arreguin by email Jessica.Arreguin@chaffey.edu if: • you plan to be absent from class (24 hours advance notice is required) so that your interpreter/captioner can be cancelled for that day. • you become sick suddenly and will miss class so that your interpreter/captioner can be cancelled for that day. • your class will be cancelled for the day so that your interpreter/captioner may be cancelled for that day. • you plan to drop the class so that your interpreter/captioner can be removed from the schedule for that class for the rest of the semester. • If you are not in class when it starts, the interpreter/captioner will wait 15 minutes for every hour of the class. • If you miss two (2) class meetings without informing Jessica Arreguin, then your accommodation services will be temporarily suspended. You will have to meet with the DPS Director before interpreting/captioning/scribe services are resumed. • All requests for interpreter/scribe/captioning must be made by submitting this form. Once Submitted DPS will arrange to accommodate your needs. You must provide advance notice (at least 1 week) so your interpreting/live-captioning/scribe services can be arranged.