INSTRUCTIONS:

Please fill out the information below and submit this request to the CLDE Department. Allow at least two weeks for completion. CLDE will confirm the request with the contact person listed below. You will be held responsible for pick up, care and return of the equipment. Please call before you come to pick up or drop off the equipment to make sure that Rosa Vicky or Mercedes are in the office and available to help you sign the equipment forms. The phone number is 303-340-0510, Ext. 28312 for Mercedes and 28383 for Rosa Vicky. Thanks!

One request per form. Please make sure to keep a copy for your records.

Please Note: Bold fields are required.
Requestor Information
School or Department:
Administrator:
Contact Person:
Position:
Contact's E-Mail Address:
Phone Number: (xxx-xxx-xxxx)
And/Or Extension:
Interpretation Equipment Request Information
Estimated Number of Audience Members who will need an Interpreting Headset/Receiver:
Number of Interpreting Systems you would like to reserve (30 headsets in each system):
Describe the Event:
Location of the Event :
Audience (e.g. parents, students, etc.):
Date of Pick Up (mm/dd/yyyy):
Person who will Pick Up Equipment:
Date of Event (mm/dd/yyyy):
Time of Event (xx:xx am/pm):
Interpreter's Name for this Event:
Date of Drop Off (mm/dd/yyyy):
Person who will Drop Off Equipment:
Additional Comments: