Form to Borrow an SIK

Please complete this form to borrow a simultaneous interpretation kit (SIK) from the New York State Office of Language Access. Submit at least 2 days in advance before the pickup date, or 10 days in advance of the shipping delivery date.

1. Contact person for this request: *This question is required.

Name: *This question is required.

Job title: *This question is required.

Agency/Organization: *This question is required.

Unit/Office (write "N/A" if you don't work for a NYS agency): *This question is required.

Work email: *This question is required. This question requires a valid email address.

Work phone number: *This question is required.

Office address: *This question is required.

2. Event details:

Name of event: *This question is required.

Date: *This question is required. This question requires a valid date format of MM/DD/YYYY.

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Time: *This question is required.

Location: *This question is required.

Description (type of event, information to be shared, target audience, expected attendance including language needs): *This question is required.

3. How are you requesting to get the SIK? *This question is required.

Please enter an 'other' value for this selection. * This question is required.

4. For Shipping: *This question is required.

Date of delivery requested (at least one business day before event is recommended to get acquainted with devices): *This question is required. This question requires a valid date format of MM/DD/YYYY.

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Date for return drop-off (this must be within five business days of event date): *This question is required. This question requires a valid date format of MM/DD/YYYY.

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5. For Pickup:
Person picking up the equipment: *This question is required.

Same as Contact Person: *This question is required.

Name: *This question is required.

Job title: *This question is required.

Agency/Organization: *This question is required.

Unit/Office (write "N/A" if they don't work for a NYS agency): *This question is required.

Work email: *This question is required. This question requires a valid email address.

Work phone number: *This question is required.

Office address: *This question is required.

6. Pickup details: *This question is required.

Date (at least one business day before event is recommended to get acquainted with devices):

*This question is required. This question requires a valid date format of MM/DD/YYYY.

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Time (between ____ and ____): *This question is required.

7. Return Details: *This question is required.

Date (this must be within five business days of event date): *This question is required. This question requires a valid date format of MM/DD/YYYY.

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Time (between ____ and ____): *This question is required.

8. Who will be interpreting for this event? (Please select all that apply.) *This question is required.

Office of General Services language services contractors
Non-contracted vendors
Multilingual staff/volunteers (only for community-based and non-profit organizations)
Other - Write In (Required) Please enter an 'other' value for this selection. * This question is required.

9. Additional notes for OLA: