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2. Request for Interpretation Services
   As a recipient of federal funds, the City of Holland, Michigan, must take reasonable steps to ensure that Limited English Proficiency (LEP) persons have meaningful access to programs, services, and information. Limited English Proficiency persons may not speak English as their primary language and may have a limited ability to read, speak, write or understand English and thus may be entitled to language assistance with respect to a particular type of service, benefit or encounter. Complete the form below if you or someone you know needs language assistance in their dealings with city government. We cannot guarantee an interpreter if the request is received less then 5 business days before the appointment.
4. What Type of Interpretation Do You Need?

   1. American Sign Language
   2. Tactile
   3. Spanish
   4. Other Language
5. What Type of Event Is It?

   1. One on One Appointment
   2. Public Meeting
7. When Do You Need the Interpreter?
   When Do You Need the Interpreter?
8. How Long Will You Need an Interpreter?
   How Long Will You Need an Interpreter? Start Time

   —

   How Long Will You Need an Interpreter? End Time
10. If Meeting In-Person Provide Meeting Location
11. If Meeting On-Line Provide Log-in Information
13. What City Department Will This Involve?

    1. Assessing Office
    2. City Clerk
    3. Community & Neighborhood Services
    4. Fiscal Services
    5. Holland Cable TV (HCTV)
    6. Human/International Relations
    7. Human Resources
    8. Management & Administrative Services
    9. Parks & Recreation
    10. Public Safety
    11. Transportation Services
    12. Youth Services
15. Person Requesting Services/Point of Contact
17. First Name
18. Last Name
20. Email Address
21. Phone Number
23. Additional Point of Contact
25. First Name
26. Last Name
28. Phone Number
29. Email Address
31. Submitting this Request for Interpretation Services affirms that this is a reasonable accommodation for a government employee, applicant, or customer for an official City of Holland sponsored meeting, activity, or program.
Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

* indicates a required field