Interpreter Services Request Form

This form is for requesting interpreter services for any PCC-affiliated program, service, or event that would potentially include Deaf students and/or Deaf patrons outside of scheduled classes. Interpreter services for scheduled classes must be requested through the Office of Accessibility Services at (252) 493-7285.

*All fields required except College

Contact Person Name:
Email Address:
Department:
College:
Phone Number:
Name of consumer or client using interpreter services:	If unsure please enter “unknown”
Event Name:
Event Date:
Event Start Time:
Event End Time:
Event Location:
Description of Request: