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Interpreter Questionnaire
Home
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For Interpreters
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Interpreter Questionnaire
Interpreter Questionnaire
Alicia Lane-Outlaw
2016-05-24T12:02:46-07:00
Please fill out the following information. Leave any fields blank that are not applicable to you.
Name
*
First
Last
Business Name
Website Info
Are you a current member of RID?
*
Yes
No
RID/NAD Certification
Membership Category
Expiration date on RID membership card
If pre-certified, have you passed any of the following?
NIC Written Exam
CDI Knowledge Exam
EIPA Written Exam
EIPA Performance Exam
None
If you are pre-certified, we will need a video sample of your work.
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, please answer the next three questions
Are you a CODA or Deaf Interpreter?
Have you taken workshops or other training in ethics or the Code of Professional Conduct (CPC)?
Please list three professional references:
Reference 1
Name
Phone/Email
Reference 2
Name
Phone/Email
Reference 3
Name
Phone/Email
Please choose from the drop down menus below as to your preferences for work settings.
Community
*
Choose one
Preferred
Acceptable
Not Acceptable
Medical
*
Choose one
Preferred
Acceptable
Not Acceptable
K-12
*
Choose one
Preferred
Acceptable
Not Acceptable
Post Secondary
*
Choose one
Preferred
Acceptable
Not Acceptable
Mental Health
*
Choose one
Preferred
Acceptable
Not Acceptable
Developmentally Disabled/Aide
*
Choose one
Preferred
Acceptable
Not Acceptable
DeafBlind
*
Choose one
Preferred
Acceptable
Not Acceptable
Oral Transliteration
*
Choose one
Preferred
Acceptable
Not Acceptable
Religious
*
Choose one
Preferred
Acceptable
Not Acceptable
Are there any additional settings in which you prefer to work?
Are there any additional settings in which you prefer NOT to work?
General Availability for Interpreting Work
Please describe your preferred pay structure
Contact Information:
Home Phone
Mobile Phone
Primary Email Address
*
Secondary Email Address
Mobile Number for Text Messaging (optional)
Residential / Postal Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
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Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
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Austria
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Bahrain
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Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
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Fiji
Finland
France
French Polynesia
Gabon
Gambia
Georgia
Germany
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Kuwait
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Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
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Malaysia
Maldives
Mali
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Mauritius
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Netherlands
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Nigeria
Northern Mariana Islands
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Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
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Samoa
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Suriname
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Vanuatu
Vatican City
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Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Country
Birthday (Month/Day)
Additional Comments
Today's Date
*