DHHS Captionist Interpreter Request

Santa Monica College
Student Support
Center for Students with Disabilities
Student Resources
DHHS Interpreter/Captioner Request

For classroom requests, you must meet with a counselor. For all other requests, fill out the form below.

Please don't fill out this input box.

STUDENT INFORMATION

Name: *

Email Address: *

REQUEST INFORMATION

Service Requested: *

Interpreter

Captionist

Service needed for: *

Tutoring

Meeting/ Appointment

Other

If other, please specify:

I NEED SERVICE FOR

For one-time requests, specify your date and start/end times.

Start date & start time:

End date & end time:

For weekly requests, specify your days and times. If your schedule varies by day, specify in the comment box.

Start date & weekly start time:

End date & weekly end time:

Where: *

Please enter any questions or comments below: Before clicking "submit" below, please make sure all information is complete to ensure services can be provided.

I have read the Student Rights and Responsibilities and agree to follow it. I agree to the terms for requesting DHHS services: *

I Agree