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Statewide Interpreter Referral Service Evaluation Form

The Nebraska Commission for the Deaf and Hard of Hearing wants to provide effective sign language interpreter referal services. We would like to know if you are satisfied with the service that we have provided.

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.

In the last nine months, I have used the Statewide Sign Language Interpreter Referral Service or have been contacted by the Statewide Sign Language Interpreter Referral Service.
Choose only one:






My contact with the Statewide Sign Language Interpreter Referral Service has been:
Choose only one:






Please rate the following questions #1-7:
1 = Poor
2 = Below Average
3 = Average
4 = Above Average
5 = Superior

  1. The availability of the Stateside Interpreter Referral Service?





  2. The response time of the Statewide Interpreter Referral Service?





  3. Access to the Statewide Referral Service?





  4. Information about the Statewide Interpreter Referral Service?





  5. The service provided by the staff of the Statewide Interpreter Referral Service?





  6. Relevant information regarding the interpreting assignment?





  7. The policies and procedures of the Statewide Interpreter Referral Service?






(optional)

What area of the state do you live in? (check one)






Thank you for your time in completing this form.

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