SOURCE_FILE: /home/univtr5/sandbox.univtrans.com/corpus/11-10 Revised Nov-Dec. T. Nishikawa-UTS Interpreter Request.doc
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 University Translators Services, LLC
ORAL INTERPRETER REQUEST FORM
EMAIL REQUEST TO: REQUEST@UNIVTRANS.COM
ONLINE FORM WEBSITE: 
 HYPERLINK "http://univtrans.com/interpreter-request-form/" 
http://univtrans.com/interpreter-request-form/
Requested By:
Submission Date (Today's Date): 
11/10/2022
Name (Your name):
Laura Williams
Company / Organization Name:
Walled Lake Schools
(Phone number / Fax number::
Phone: 248-956-4050
FAX: 248-956-4065
Email Address:
LauraWilliams@wlcsd.org
Date & Time of Service:
SERVICE DATE (please include DAY and DATE in writing): 11/22, 11/29,12/1, 12/6,12/8,12/13,12/15,12/20, 12/22
MO TU WE TH F SA SU (please also circle the day of the week)
(Start Time: (write start time below)
Tuesdays: 8:30
Thursdays: 8:30
End Time: Tuesdays: 9:30, Thursdays: 12:10
Number of Hours You Want to Reserve
Please indicate how many hours you want to reserve?1 (2-Hour min.)
Interpreter Request Information: (X CONSECUTIVE ( SIMULTANEOUS (ASL (CART
Language and Country of Origin: 
Japanese
Name of the Limited English Proficient (LEP) Person(s) and include title (e.g. parent, student, defendant, patient, witness, juvenile, suspect, etc.)
Miho and Atsushi Nishikawa, Parents of Takumi, a child receiving Early Intervention Support
Subject Matter (testing, consultation, mental health)
Early Intervention Consultation
Type of Appointment (e.g. IEP, prelim hearing, pretrial, medical appointment, sentencing): 
Early Intervention Support for Mother and Child
Case /Patient/Consumer Number
Date of Birth (if applicable): 
Other Participants Names/Titles (e.g. Attorneys, Prosecutors, Witnesses, Teachers, etc.):
Laura Williams, Early Interventionist
Please add or attach pages that include any other information related to your request; the more informed your interpreter is the better! 
(REMOTE VIDEO INTERPRETING (RVI) (e.g. Zoom, GoogleMeet etc.) (TELEPHONE OR (X ON-SITE
ON-SITE LOCATION NAME
The Nishikawa Home
Address / City / State / Zip
41639 Mitchell Rd, Novi, MI 48377
Remote Link, Meeting ID, Password
Meeting Contact Person
Laura Williams 
(Meeting Contact Person Cell Phone
(248) 252-8520
Billing Information (Where and to whom should we send the invoice?):
Organization Legal Name for Billing
Walled Lake Consolidated School District
Address / City / State / Zip
850 Ladd Rd Bldg D
Walled Lake, MI 48390-3086
Name of Billing Contact
Anne Roeser
(Phone number: / Fax number:
248-956-2165 anneroeser@wlcsd.org
Billing Contact Email Address:
anneroeser@wlcsd.org
We will check availability and update you within 24-48 hours. A confirmation number will be forwarded to you via email after an interpreter has been reserved. If you do not receive a confirmation, please call UTS at 734-665-7295!
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UNIVERSITY TRANSLATORS SERVICES, LLC
Williams, Laura
Normal
Williams, Laura
Microsoft Office Word
University Translators Services
UNIVERSITY TRANSLATORS SERVICES, LLC
Title
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