I am a deaf person. As such, I am a person with a disability under the meaning of the Americans with Disabilities Act, Section 504 of the Rehabilitation Act of 1973 as amended, and the Michigan Persons with Disabilities Civil Rights Act. Pursuant to all applicable laws, I am requesting the services of a qualified sign language interpreter for the deaf as a reasonable accommodation.

Writing notes will not provide me with effective communication because:

Our communication is too complex Our communication will last too long

My reading skills are weak Other ____________________________________________

Interpreter Request Information:

Location: __________________________________________________________________

Address:___________________________________________________________________

Time: _____________________________________________________________________

Communication Preference(s)___________________________________________________

_________________________________________________________________________

This request is made to (Name of Person receiving request)_________________________________

Of (Name of agency or organization)________________________ Date_____________________

___________________________________
(Print Name)

___________________________________
(Signature)

The ADA provides: "A qualified interpreter means an interpreter who is able to interpret effectively, accurately, and impartially both receptively and expressively, using any necessary specialized vocabulary." Guidance from the Department of Justice further provides, "This definition focuses on the actual ability of the interpreter in a particular interpreting context to facilitate effective communication between the public entity and the individual with disabilities . . . The definition of "qualified interpreter" in this rule does not invalidate or limit standards for interpreting services of any State or local law that are equal to or more stringent than those imposed by this definition. For instance, the definition would not supersede any requirement of State law for use of a certified interpreter in court proceedings." (See http://www.usdoj.gov/crt/ada/reg2.html)

ADA Information Line: 800-514-0301 (voice) 800-514-0383 (TDD) ADA website: http://www.usdoj.gov/crt/ada/adahom1.htm
Michigan Division on Deaf and Hard of Hearing: 877-499-6232 V/TTY * DODHH website: http://www.michigan.gov/cis/0,1607,7-154-28077_28545_28559---,00.html
Copyright Celeste Johnson, 2003. Reprinted with permission. This form may be freely reproduced and distributed on the condition that this notice appears on all copies.