ATTACHMENT “C” Superior Court of California, County of Contra Costa DOMESTIC VIOLENCE INTERPRETER REQUEST FORM Case Number: ______________________________ Date: _________________________ Case Name: _______________________________________________________________ Party Requesting Interpreter: __________________________________________________ Phone Number(s) where Party can be reached: ____________________________________ Type of Hearing: □ □ Court Appearance Mediation Session □ □ Orientation Other: ___________________________ Date of Appearance: __________________________________ Time: ________________ Department: ________________________________ and/or Location: ________________ Language Needed: __________________________________________________________ Notice to Party: An interpreter has been scheduled for you only for the date and time indicated above. You may request that an interpreter be scheduled for other non-DV hearings in the future, however, approval will depend on continued availability of funding. You must call the Interpreter Coordinator at (925) 957-5777, at least 14 days prior to the scheduled hearing in order to request and obtain approval for the appearance of an interpreter for any future date. The Court has determined that the above party has sought, or been granted, or is responding to a restraining order pursuant to California Family Code Section 6221 and does not proficiently speak or understand the English language. Request Form Completed by: ______________________________________________________ on _________________ Name / Department / Phone Number Date Date Request was forwarded to Martinez Interpreter Coordinator: ______________________ American LegalNet, Inc. www.FormsWorkFlow.com FamLaw-222 / Revised 08-03-2007