Interpreter Questionnaire

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*
Medical*
K-12*
Post Secondary*
Mental Health*
Developmentally Disabled/Aide*
DeafBlind*
Oral Transliteration*
Religious*
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 Country
Birthday (Month/Day)
Additional Comments
Today's Date*