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Language Access Services (Grant Funded)
Interpreter Request
(in-person or virtual only)
Appointment Information
Appointment Date
Appointment Time
Language/Dialect
Appointment is:
*
In-person
Virtual
Appointment Duration
Number of Interpreters
Patient/Client Name (if appt. is for medical/health purposes only provide initials)
Preferred Gender of Interpreter
Physical Address of Appointment (all relevant information an interpreter would need to know to find location)
Virtual Information (connection platform link or phone number)
Provider Name
Provider Phone Number
What is the purpose of the appointment?
Requester Information
Requester Name
Requester Organization Name
Requester Email
Requester Phone Number
What grant will fund your request? If you are not sure, contact LARC at LARC@dupagefederation.org or (630) 782-7544.
Submit
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