Please fill out the following information.

Leave any fields blank that are not applicable to you.
Name * First Last
NIC/ RID/ NAD Certification:

NIC/ RID/ NAD Certification: (Please specify "NAD IV", CI, NIC etc.
Are you a current member of RID? * Yes No
Membership Category

(Certified, Associate, Student etc.)
Expiration date on RID membership card / MM / DD YYYY
If pre-certified, have you taken and passed any of the following? RID CI/CT Written Exam NIC Written Exam EIPA Written Exam EIPA Performance Exam None
If you have taken the EIPA Performance Exam or ESSE Performance exam, answer at least one of the next three questions (or more if applicable)
EIPA Primary (Elementary Level) Performance Score
EIPA Secondary (High School) Performance Score
ESSE Score(s)
Name of program or institution where you received training to become an interpreter
Post secondary degree(s) earned
Major /Minor
If you have no academic training, answer the next three questions
Are you a CODA?

Note here if you are a CODA, have other Deaf Family Members, or other way you acquired sign language fluency.
If not, how did you acquire sign language fluency?

Note here if you have other Deaf Family Members, learned through friends etc.
Have you taken workshops or other training in ethics and or the professional code of conduct?

(if yes note when and where)
Please choose from the drop down menus below as to your preferences for work settings.
Community: *
K-12 *
Post Secondary *
Medical *
Mental Health *
Legal
Developmentally Disabled Deaf *
Deaf-Blind *
Oral Transliteration *
Religious *
Are there any additional settings you prefer to work in?
Are there any additional settings not or situations not mentioned you prefer to NOT work in?
General Availability for Interpreting Work

Tell us about your general availability for work. Please write a short description of the months, days of the week or other time period you are generally available. Please include your plans for the next 3 to 4 months
Contact Information:
Home Phone - (###) - ### ####
Cell Phone - (###) - ### ####
Primary E mail Address *
Secondary E mail address

Enter a second e mail address if you have one
Text Messaging Device E mail address

Enter the full e mail address of a mobile text messaging device (IE 9165551212@att.text.net) Do not enter your cell phone number only.
Residential / Postal Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Birthday

We don't need to know your age. Month and day is fine.
Additional Comments

Add notes about anything you would like to add or clarify
Today's date * / MM / DD YYYY

Please fill out the following information.

If you have taken the EIPA Performance Exam or ESSE Performance exam, answer at least one of the next three questions (or more if applicable)

If you have no academic training, answer the next three questions

Please choose from the drop down menus below as to your preferences for work settings.

Contact Information: