City of Detroit ASL Request Form

City of Detroit ASL Request Form

REQUESTOR INFORMATION

Who is submitting the request?*

Constituent / Resident

City of Detroit Employee

City Council Staff

Please select the identity which most closely corresponds to the constituent for whom the request is being submitted.*

I am Deaf / Hard of Hearing

I am DeafBlind

I am filling this out for a Deaf / DeafBlind / Hard of Hearing constituent

Requestor's Name*

Requestor Pronoun

She/Her

He/Him

They/Them

Other

Requestor's Title

Requestor's Department*

Select

If you selected Other, please name the Department below.*

Office/Division

District

Select

Requestor's Phone Number

Requestor's Email*

Request Type*

Select all that apply.

Deaf / Hard of Hearing client

DeafBlind client

Walk-ins at a public event

Please provide the name of the client needing ASL services below.*

Client Pronoun

She/Her

He/Him

They/Them

Other

INTERPRETING SERVICE DETAILS

What is the name of the event or proceeding for which you are requesting ASL interpretive services?*

On what date will ASL interpretive services be needed?*

Please note that the Office of Disability Affairs needs at least 7 business days notice to properly process an ASL request. We may be able to process urgent requests in a shorter amount of time, but there is no guarantee.

At what time will the proceeding or event begin?*

Please use the format 00:00 AM/PM.

At what time will the proceeding or event end?*

Please use the format 00:00 AM/PM.

Please select the type of proceeding or event for which ASL services are being requested.*

Applications for City Services

General presentations and/or community workshops

Employment (Interviews / Staff Meeting / Training / Grievances / Discipline)

Meetings

News Reporting, Press Conference, Video / Audio Recordings

Political / Election events

Social and recreational activities

Please indicate the subject matter that will be covered at the presentation, workshop, or event.*

Employment / Finance / Official government business

Medical / Mental Health related matters

Legal / Law Enforcement matters

Not related to health, mental health, legal, employment, finance, or official government business

Please select the location for provision of ASL interpretive services.*

In-person (within City of Detroit)

Remotely via video platform

Will this event be recorded and/or broadcasted?*

Yes

Please provide the website, remote software being used, and any additional details for the remote interpretive service being requested.*

What is the address of the in-person proceeding or event?*

Street, Room #, City, and Zip Code

Will free parking be available for the interpreter(s) at the in-pperson proceeding or event?*

Select

What are the name and phone number for the onsite contact?*

Contact Pronoun

She/Her

He/Him

They/Them

Other

If available, any interpreter preferences:

Please provide any additional information relevant to the ASL request below.

Because your request is for over two hours, we require the submission of an agenda or draft of show.*

Please check the box to indicate you have attached an agenda or draft of show.

Meeting Documents

Please attach a copy of an agenda, PowerPoint slides, and/or handouts to allow for effective communication at the proceeding or meeting.

Drag and drop files here or

Send me a copy of my responses

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