2025 WORLD SPEAKS' COMMUNITY INTERPRETER COURSE REGISTRATION FORM (PILOT PROGRAM)
Enter your information below
Name
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Email Address
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example@example.com
What is your phone number?
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Format: (000) 000-0000.
What is your mailing address?
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City Ciudad
State / Province Estado/Provincia
Postal / Zip Code Código Postal
What are your preferred pronouns?
*
She/her/hers
He/him/his
They/them/theirs
Prefer not to answer
What is your age range?
*
16-24
25-34
35-44
45-50
51+
What is your occupation?
*
What is your ethnicity?
Pacific Islander
Hispanic/Latino/a/ex
Asian
Native American /Indigenous
Middle Eastern
African American/black
European descent - includes white/caucasian
Biracial/Multiracial
Other
Please describe your ethnicity
What is your gender identity?
Female
Male
Non-binary
Transgender man
Transgender woman
Two-Spirit
Prefer not to say
What is your income level?
$0-$24,999
$25,000-$34,999
$35,000-$49,999
$50,000-$69,999
$70,000+
Course description
Would you like to join the World Speaks newsletter?
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Yes
No
Already subscribed!
Please list your working languages (languages you'll interpret in)
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Have you completed an interpreter course before?
*
Yes
No
Please list the details
Have you perform interpretation services before?
*
Yes
No
Only for family/friends
Are you currently providing interpreter services as part of your role?
*
Yes
No
What field of interpreting are you most interested in?
*
Legal
Healthcare/Medical
Education
Social Services (e.g.: welfare, housing, refugee and resettlement,etc.)
Employment services
Religious services
All
What are two things your instructor needs to know about you?
*
What professional goal do you have after completing this course?
*
I would like to start my own company or contract with individuals/businesses
I would like to work for a company that provides interpretation services
I would like to use these skills in my current job
I would like to improve my skills to follow a career in interpretation
I would like to use these skills to serve my community/family and for volunteering purposes
Other
Please add your professional goal here
Snacks and light food options will be provided during the course. Do you have any food allergies or dietary requirements?
*
Do you have an electronic device (laptop or tablet) you can bring with you on test day? (if you don't please email our Program Manager paulinacg@worldspeaksomaha.org asap)
*
Yes
No
I acknowledge/grant permission to World Speaks for the use of photographs or electronic media images for marketing, social media, and any other ways they see fit as far as promotional materials. I understand that I may revoke this authorization at any time by notifying Paulina Campos Guzman in writing (paulinacg@worldspeaksomaha.org). The revocation will not affect any actions taken before the receipt of this written notification. Images will be stored in a secure location and only authorized staff will have access to them. They will be kept as long as they are relevant and after that time destroyed or archived. ________________________________________________________________________________________
*
Yes
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Registration Fee
Selecting a payment option is due in order to submit form. The $15 enrollment fee that covers course materials is non refundable. I acknowledge that if I drop this course or re enroll in the same or different level of the course I will have to re submit the enrollment fee of $15 at that time.
*
Yes
Select your payment method:
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Send check/cash to: World Speaks 7914 W Dodgde Rd #475 Omaha NE 68114
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