Deaf Services Concern Sheet

* indicates required field.

Contact Information:

Interpreter Name:

* NEU Email:

Job Information:

Name (student/other):

Description of Job:

Date of Job (mm/dd/yyyy):
/ /

Time of Job:

Type of job:
Classroom Other:

* Other = Appointment, Meeting with Professor, Meeting with other Department, etc.

Concern:

Regarding:

Interpreter CART Reporter Student Other:

Please check all that apply:

Didn't show up

Late for class

Failed to inform DRC that services were not needed due to exam, field trip, etc.

Called/emailed/paged to inform that they were not going

Date of cancellation (mm/dd/yyyy): / /

Other:

Additional Comments:

Please be as specific as possible:

Disability Resource Center
360 Huntington Ave
20 Dodge Hall
Boston, MA 02115

Phone:617-373-2675
TTY: 617-373-2730
Fax: 617-373-7800