Indiana State Agency Interpreter Request Form

Please Note: If required fields below (designated with a *) are not completed, your request will not be scheduled. If your request is for an appointment within the next 24 hours, please contact our office directly at 317.341.4137, Option 1.

  • General Information

  • Requestor Information

  • Appointment Information

  • (physical address or virtual link)
  • (parking, door number, etc.)
  • Please provide additional appointment details above (examples would include: home visit, family has a cat; therapy, meeting with school counselor, court case involved, etc.).
  • If yes, please provide additional appointment details above.
  • Per the state contract, if an interpreter travels over 25 miles one way, they qualify for paid round-trip travel time. Do you approve this expense if the assigned interpreter must travel over 25 miles one way?
  • If you answered No to the question above, please select how you would like us to proceed.
  • If desired, please provide a listing of preferred interpreter(s) (optional)
  • If desired, please provide a listing of banned interpreter(s) (optional)
  • Please Note: In conjunction with this appointment request, please forward any attachments or prep materials to

  • This field is for validation purposes and should be left unchanged.