Inclusive Language Services Survey Question Title * 1. Organization Name: (Required.) Question Title * 2. Language Access Coordinator Contact:(or Language Access Policy Interest Contact) (Required.) Question Title * 3. Contact Phone # (Required.) Question Title * 4. Preferred Contact Method: (Required.) Email Phone Either Question Title * 5. Languages Spoken by Staff:Please list all languages spoken fluently by staff who serve clients directly. (Required.) Question Title * 6. Do you have a Language Access Policy? (Required.) Yes No No, but interested in developing one. Question Title * 7. When would it be appropriate for other organizations to contact you for language support? Please check all that apply. (Required.) Intake, Applications & Eligibility Interpretation Reviewing Service Plans & Instructions Safety or Emergency Services Interpretation Multi-Party Coordination Interpretation (Conference Calls, Virtual Meetings) Informed Consent & Rights Interepretation Written Translation of Materials Cultural Navigation Services N/A Other (please specify) Question Title * 8. If you use translation, interpretation, or other language support technology, what are the services and devices you use? If none, please list n/a. (Required.) Question Title * 9. Please review the Language Services Seal requirements here. Do you meet the criteria to obtain the Inclusive Language Services Seal? (Required.) Yes No Question Title * 10. Please share any additional feedback or questions here. Thank you! Done
