Interpreter Request Form

Interpreter Request Form

Please fill out this request form as completely as possible.

This request is NOT a confirmation of an interpreter. We will contact you when your request has been filled.  

If you have not heard from us within a week and would like to inquire about your request status, please email us at brownj@hendrix.edu or call 501.505.2954.

Please make sure you have read the procedures for making a request for interpreter or captioning of an event. 

Date and Time Details

Service Start Date:   [None]   
Service Start Time:   AM  PM  

Service End Date:   [None]   
Service End Time:   AM PM

Event Details

Location: 

Type of event:  Class or Class Related Student Orientation Campus Event Fine Arts (Music, Event, Theatre) Campus Tour, Showcase Saturday, Orientation Other/Community member

If other, describe: 

Event Coordinator / On-Site Contact's Name: 

Event Coordinator / On-Site Contact's Phone: 

Type of service requested:  ASL Oral/Sign Support Other   (you can select more than 1 item.)

If Other, please specify: 

Special Requests:   

Requester's Information

Name: 

Phone: 

Email: 

Title:  Student Parent Faculty/Staff Department Head, Dean, Supervisor Other/Community Member

Client Information (if different than requester) 

Client Name:

Client Phone:

Client Email: 

Other Information:   

Note: Request for program accommodation should be received 7 days prior to the event. Persons seeking accommodations are encouraged to purchase seats as soon as possible and to notify the box office when reserving if special assistance or accommodations are needed for participation in events.