2016 Version Interpreter Data Sheet.docx

DOCX document 80 KB Posted Apr 23, 2015

Attached to: MCD01 Interpreter Contract Renewal for FY'16 to FY'18 Period
Solicitation number: BD-15-1067-MCD01-MCD01-00000003934
Issued by: Suffolk County, Massachusetts

About this file

Written by GovTribe AI · Aug 6, 2024

This document is a provider data sheet for the Massachusetts Commission for the Deaf and Hard of Hearing's (MCDHH) Department of Interpreter/CART Services. It requests information from interpreters and CART providers who wish to be considered for work under MCDHH's MCD01 Contract for Interpreters and Transliterators for the Deaf and Hard of Hearing. The data sheet covers the providers' contact information, communication skills, geographic areas they are willing to work in, types of assignments they are willing to accept, and insurance coverage. The contract opportunity relates to renewing the MCD01 contract for the FY'16 to FY'18 term.

The data sheet is required to be completed and submitted along with the providers' contract documents. MCDHH will use the information provided to maintain a directory of qualified interpreters and CART providers available for various assignments, including ceremonies, court, education, employment, medical, mental health, social services, and substance abuse programs. Providers must indicate their willingness to be contacted for after-hours and weekend emergencies, as well as for work at private colleges and universities.

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The Commonwealth of Massachusetts Executive Office of Health and Human Services Massachusetts Commission for the Deaf and Hard of Hearing 600 Washington Street Boston, Massachusetts 02111 Tel. (617) 740-1600

TTY (617) 740-1700

VP (617) 326-7546

Fax (617) 740-1880 www.mass.gov/mcdhh

Department of Interpreter/CART Services

INTERPRETER/CART PROVIDER DATA SHEET

Complete and return with your contract documents Please inform the Department of Interpreter/CART Services of any changes in this information

First Name:

Last Name:

Street Address:

City/Town:

State

Zip + 4

Home phone:

Primary email:

Work phone:

Videophone:

Mobile phone:

Alternate email/contact number:

Pager

Communication Skills (check all that apply):

CART Provider

Oral Transliterator

Interpreter

CDI/SDI

Transliterator

I am willing to be contacted for work in the following regions (check all that apply):

Boston/Metro

Western

Northeast

Southeast

Central

Cape Cod/Islands

DeafBlind - Tactile DeafBlind – Close Vision DeafBlind – Rochester DeafBlind – Other:

DeafBlind – Tracking DeafBlind - ProTactile

I carry the following insurance:

Liability insurance

Malpractice insurance

Other insurance (specify)

I am willing to be contacted for the following (check all that apply):

Ceremony/Weddings/Birth/Funeral Court Education 0-12 Education/Post-Secondary Education/Meeting Education/Personal Growth Education Conference/Workshop Employment/Conference/Workshop Employment/General Employment/Meeting General Audience Jury Duty Legal Conference/Workshop Legal Emergency MCDHH Referral/Interpreter Substitute Medical Conference/Workshop Medical Emergency Medical Meeting Medical/Clinic Medical/Doctor Office Medical/Hospital Medical/Residence Mental Health Conference/Workshop Mental Health Emergency Mental Health Meeting Mental Health/In-patient Mental Health/Out-patient Miscellaneous Meetings Non-court Legal Personal Business/Meeting Social Services Social Services – Conference/Workshops Social Services/Emergency Substance Abuse Support Groups (e.g. AA/NA) Substance Abuse Workshop/Training Substance Abuse/Detox Substance Abuse/Out-patient Services Substance Abuse/Residential Treatment Support Group/Other (e.g. cancer, bereavement, etc)

I am willing to be contacted by hospitals for after business hours and weekend emergencies I am willing to be contacted by private colleges and universities for post secondary work I am willing to be contacted by requestors for theater/performing arts work

Signature

Date

2016_Version_TerpDataSheet_150421 image1.wmf oleObject1.bin

File details come from the government source that posted it. Updated Aug 6, 2024.