VOICE Inc. Saginaw, Michigan

Request Form

I am a deaf person. As such, I am a person with a disability un the meaning of the Americans with Disabilities Act, Section 504 of the Rehabilitation Act of 1973 as amended, and the Michigan Persons with Disabilities Civil Rights Act. Pursuant to applicable laws, I am requsting the services of a qualified sign language interpreter for the deaf as a reasonable accomodation.
Service Requested
Other (please Explain)
Requestor Name *
Requestor Agency
Requestor Phone# *
Requestor fax#
Requestor email *
Date Service Needed
Time of Service *
Client Name *
Location for Service *
Address *
Preferences

Confirmation Once your request has been received in our office, we will send an email and/or fax to let you know your request is pending. A confirmation/authorization will be faxed once a qualified contractor has been assigned.

Service Request Form