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Contact Information

Name * Business Address *   State AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VA WA DC WV WI WY Business Phone/Mobile Phone Email */Mobile Mail Video IP Address TIN (SS#)

Qualification

Government Medical Medical specialty Legal Court ED K - 12 ED Post Secondary

Education

AAS BA BS MA MS

Certification

BEI Master   Avanced   Basic   V IV   III   II   I OC:B   OC:C   OC:V   NIC Master   Avanced   Certified     RID CI   CT   CSC   SC:L OIC:S   OIC:C   IC   TC IC/TC   CI/CT   CDI   RSC   NAD V   IV       CART RMR   CRR   RPR   CSR CR                   Specialty Training

Rate Information

Regular   After Hours EM Regular   Less Than 1 EM After Hours

Interpreting Services (check all that apply)

Sign Language and Oral Interpreting and Transliteration Services English / American Sign Language Interpretation English / English Based Sign Language Transliteration (MCE, SEE II, Signing Conceptual English, etc.) Oral Transliteration Theatrical / Special Event Translation and Presentation Spanish / American Sign Language / English Trilingual Interpreting Services Deaf Blind Tactile or Close Vision Services Sight Translation     Intermediary Services Certified Deaf Interpreter Services (CDI) Foreign Sign Language Intermediary Services Minimal Language and Gestural Communications     Medical Specialty Services Serious or Complex Medical Consultations and Procedures Advanced Communications with Physicians and Healthcare Providers Medical or Bio Medical Degree Programs 24 hour emergency coverage Interpretation for “Informed Consent” for treatment or disclosure of health information     Legal Specialty Services Interpreting and Transliteration of Legal Documents Interpreting and Transliteration for Legal Consultations Municipal, State and District Court Proceedings     Educational Services Admissions and testing Orientation, interviews, conferences, ARD meetings, commencements and special events, etc. Educational coursework Human Resources and EEO Substitute service provision Translation and production of educational materials Extra curricular activities

Text Services (check all that apply)

Voice to Text or Written Language Services Computer Aided Real Time Reporting (C.A.R.T.) C Print Note taking

Service Consulting (check all that apply)

Effective Communication Strategies “Reasonable Accommodation” and “qualified” as defined by Section 504 of the Rehabilitation Act and the Americans With Disabilities Act Health Insurance Portability and Accountability Act (HIPAA) Joint Commission on Accreditation of Healthcare Organizations (JCAHO) In Service Training on effective communication strategies Effective Community Program Planning to include persons who are Deaf or hard of hearing

Training and Development Services (check all that apply)

Internships to match required coursework for sign language interpreting degree programs Apprenticeship programs for entry level, advanced language or specialty Medical Specialty Legal Specialty Mentorships Hands on language and protocol training in client specific venues Staff Development Evaluation of work skills Language specific training

Employment Desired

Administrative Support Staff Interpreter Staff Independent Contractor Internship or Apprentice Mentor Intermediary

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