Sign Language Interpreter Complaint Form

The Statewide Interpreter Referral Service of the Nebraska Commission for the Deaf and Hard of Hearing wants to make sure you are getting the highest professional service possible. This form is to be used by a deaf or hard of hearing person or an agency/business who utilized the services of an interpreter, and was not satisfied with interpreter services provided. This complaint will be placed in the interpreter's permanent file. Interpreter's are allowed to see what is put in their individual files.

Information received from the submission of forms that are posted on the Nebraska Commission for the Deaf and Hard of Hearing (NCDHH) web site, is used for business use only. Information collected through the submission of forms will not be resold for commercial use, all information will be kept confidential.

Entries marked with an * is required information.

Date of the Interpreting Assignment: * (month/date/year)

Time of the Interpreting Assignment: *
(beginning time to ending time)

Name of Person or Agency/Business Involved: *

Place of the Interpreting Assignment: * (give the address and the city of the interpreting assignment)

Explain what interpreter service(s) you were not satisfied with: *

Person Filing This Complaint Form

Name:*

Phone Number: * Voice TTY Both
(include area code)

E-mail Address:*

Is there any additional information that you would like to share with the Nebraska Commission for the Deaf and Hard of Hearing?

Thank you for your time in completing this form, the Interpreter/Program Coordinator will be contacting you in a timely manner.

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