REQUEST FOR AUXILIARY AIDS AND SERVICES
Resident Name ___________________________Resident # _________ Date:______
Federal law requires Youth Services International, Inc., to furnish appropriate auxiliary aids and services where necessary to ensure effective communication with individuals with disabilities. Such auxiliary aids and services may include: qualified sign language or oral interpreters, notetakers, computer-assisted real time transcription services, written materials, telephone handset amplifiers, assistive listening devices, assistive listening systems, telephones compatible with hearing aids, closed caption decoders, open and closed captioning, videotext displays, and TTYs.
Resident signature: ________________________
Signature of ADA Coordinator: __________________ Date: _____________