dis-Ability Access

	Western Piedmont Community College - (828) 438-6000, TDD 438-6066
	1001 Burkemont Avenue, Morganton, NC 28655-4504

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DA Forms -

dis-Ability Access

Online Request / Cancellation Form for
Interpreter and Transcriber
"No Show" Policy

Student's Full Name:
Student's Phone: (Ex. 828-438-5555)
Student's Email Address:
I am requesting an (a):	Interpreter Transcriber
I am cancelling an (a):	Interpreter Transcriber
Title of Event or Class:
Building and Room number: (Ex. Carr Hall 244)
Date of Event or Class: (Ex. Oct. 3, 2008 or 10/3/2008)
Beginning Time of Event or Class: (Ex. 8:00 A.M. or 7:00 PM)
Ending Time of Event or Class: (Ex. 8:00 A.M. or 7:00 PM)

I understand that it is my responsibility to:

Notify the Interpreter Coordinator of class or schedule changes.
Notify the Interpreter Coordinator 24 hours in advance if I am unable to attend the event or will be absent from class.
Notify the Interpreter Coordinator if my assigned interpreter is unable to meet my language needs.
Request services at least 3 business days in advance. Less notice may mean services are not available.

Sending this form indicates that you understand the above responsibilities.