The code block below illustrates how one might use # and // as comments in your logic and calculations.

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Required format:

2UoZsZWffuIhtvnJsdZvGkGwuvGX2knr9496D2M45FvKSecqHqbdc

Access Request for Deaf Professional/Learner - DPIS

Returning?

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IMPORTANT: This form is specifically for Deaf employees, professionals, scholars, learners, visitors, and community members.

FOR PATIENTS, please contact Patient Care Interpreting Team by calling (585) 275-4778 or emailing Interpreter_Services@urmc.rochester.edu or visit their webpage. We do not provide services for Deaf and Hard of Hearing patients.

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For general/non-urgent scheduling and billing questions, please email DeafProfessional_InterpreterServices@urmc.rochester.edu.

Business hours: Monday-Friday, 8:30 am to 5:00 pm Eastern Time.

For urgent requests (within 36 hours) or after-hours: please text 585-484-0086 as we do not monitor our inbox over weekends, during holidays, or after 5pm during the week.

Requester Name

* must provide value

Requester's Email (we will contact for any questions)

* must provide value

Name(s) of Deaf Professionals/Learners/Attendees

* must provide value

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Type of Access
(you may check more than one)

* must provide value

American Sign Language Interpreting (in-person)

Real-Time Captioning (remote)

ZOOM / Remote Interpreting

Other

Please specify

* must provide value

Event Title

* must provide value

Is this event recurring?

* must provide value

Yes

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Event Date

* must provide value

Please list all dates associated with this event.

* must provide value

Start and End Time

* must provide value

Event Location

* must provide value

In-Person

Virtual

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Building Name (or Street Address if not at River Campus or URMC)

* must provide value

Room Number

* must provide value

If the area requires swipe access, and the interpreter is not a UR employee, who can the interpreter contact to be let in? (ie: name, phone number, text number, etc)

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Virtual Meeting Link

* must provide value

If recurring, will the zoom link be the same for all dates?

What is the nature of the appointment or event? (e.g., educational class, 1:1 or group meeting, weekly department meeting, lab session - please specify the type of lab, etc.)

* must provide value

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Please indicate the role of the Deaf individual (e.g. UR/URMC or external, student, staff, faculty, researcher, visitor/community member, etc.)

* must provide value

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Do you have any special instructions or requests for the interpreter? (e.g., directions for those unfamiliar with your room, dress code, food/drink restrictions, allergy considerations, etc.)

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Who should the interpreter contact directly to obtain further information such as a copy of the presentation slides and/or speaker's notes, if applicable?

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Will this event be recorded or live-streamed?

* must provide value

Yes

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Would you like the ASL interpreters to remain and provide ASL interpreting even if there is no Deaf attendee?

* must provide value

Upload any relevant files for the event here (e.g. conference agenda, powerpoint slides, event flyer, presenter biographies)

Upload file

Department Name

* must provide value

Company Number

* must provide value

Grant Account Number (if applicable)

Department Contact Name

* must provide value

Department Contact Email

* must provide value

are there any additional deaf professionals? Please share names.

What are the names of the Deaf/Hard of Hearing attendees?

Any special instructions for the interpreters? E.g. dress code, food, drinks, parking, etc.

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