ASL & CART Request Form Which Services Are Being Requested? * ASL CART ASL & CART Event Information Event Title * Type of Event * Select OneStaff Meeting1:1 meetingInterviewTraining/Workshop/ConferenceMedical LectureOther If other, please describe: * Number of Event Participants * less than 1011-5051-100100-200greater than 200 Date of Event * Start Time * 121234567891011 : 00153045 AMPM End Time * 121234567891011 : 00153045 AMPM Is this event in-person, hybrid or virtual? * in-personhybridvirtual Is the employee needing services participating in person or virtually? * in person virtually Address * Address Street Address Street Address Building Name, Suite, Room Number Building Name, Suite, Room Number City City State/Province State/Province Zip/Postal Zip/Postal Will parking be provided for the service provider? * Yes No Parking Instructions * Specific Instructions for Service Providers Upon Arrival * Virtual Website/URL * Passcode Call-in Number * Would you like to request additional events? (up to six events) Yes Event Title (Additional Event 1) Date Start Time 121234567891011 : 00153045 AMPM End Time 121234567891011 : 00153045 AMPM Event Title (Additional Event 2) Date Start Time 121234567891011 : 00153045 AMPM End Time 121234567891011 : 00153045 AMPM Event Title (Additional Event 3) Date Start Time 121234567891011 : 00153045 AMPM End Time 121234567891011 : 00153045 AMPM Event Title (Additional Event 4) Date Start Time 121234567891011 : 00153045 AMPM End Time 121234567891011 : 00153045 AMPM Event Title (Additional Event 5) Date Start Time 121234567891011 : 00153045 AMPM End Time 121234567891011 : 00153045 AMPM Event Title (Additional Event 6) Date Start Time 121234567891011 : 00153045 AMPM End Time 121234567891011 : 00153045 AMPM Point of Contact Point of Contact’s Name * Title/Role * Department/Unit/Organization/Affiliation * Email * Phone * Employee Receiving ASL and/or CART Services Employee’s Name * Employee’s Preferred Contact Method * Videophone Phone Text Email Employee’s Role * Presenter Participant OtherOther Email * Phone * Additional Services (Please ask Deaf attendee) Close Vision Tactile Interpreting Please include specific instructions for the interpreter. * Are additional accommodations needed to support access for the employee? If so, please explain: If more than one employee needs ASL services please provide their names, contact information, and other applicable details. Preparation Materials You will be asked in a follow up email to provide any additional materials that could assist our service providers such as websites, event flyers, agendas, PowerPoint slides, videos, handouts, job descriptions, definitions, event or subject matter specific terminology, acronyms, participation format, etc. Area for Links or Additional Information Submitting this form does not guarantee an ASL interpreter or CART provider will be available for the requested event. After submitting this request, if services are no longer needed, please contact ASLCARTRequest@umich.edu as soon as possible to cancel. If you are human, leave this field blank. Submit
