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Department LEP Encounter Form
Department LEP Encounter Form
Department LEP Encounter Form
Staff Name that Encountered the LEP
(Required)
Name of Division, Section, Branch, Program, Office or Attached Agency:
(Required)
Date of Encounter:
(Required)
Month
Day
Year
Method of Encounter with the LEP:
(Required)
Phone
In-Person
Written Request
Language requested by LEP
Cebuano
Chinese-Cantonese
Chinese-Mandarin
Chuukese
Hawaiian
Ilocano
Japanese
Korean
Marshallese
Samoan
Spanish
Tagalog
Thai
Vietnamese
Other
Unknown
Other: Please specify
(Required)
Was Service Provided to the LEP?
(Required)
Yes
No
If Yes, who provided service to the LEP?
(Required)
Staff
Language Service Vendor
Volunteer
If No, why was service not provided?
(Required)
Interpreter not available
Declined service
Please add any comments:
