Division for Rehabilitation Services

Office for Deaf and Hard of Hearing Services

Court Interpreter Certification Application
DARS/DHHS will use the information provided in this form to request a criminal history conviction check from the Texas Department of Public Safety.
Applicant Information
Name:

Birth date:

Social Security number:

Address:

City:

State:

ZIP code:

County:

Daytime phone number:

( )	Alternate phone number: ( )	Email address:

1. Are you currently a certified interpreter? (enter X to select one)	Yes	No
If yes, list your current certifications and name the certifying entities (if no, you are ineligible):

2. How many hours of court interpreter training have you acquired?

Statistical Information
Gender (enter X to select one): Male Female
Auditory Status (enter X to select one):	Deaf	Hard of Hearing	Hearing
Ethnicity (enter X to select one):	African-American	Asian	Hispanic
Native American	Pacific Islander	White	Other:
Fee and Testing Information
Written Examination Fee: $175	Performance Examination Fee: Not applicable
Required Attachments
1. Copies of current certificates
2. Copies of documentation of attendance for court interpreter training
3. Signed DARS3901B, Code of Ethics and Professional Responsibility of Certified Court Interpreters
4. Check or money order payable to DARS/DHHS for examination fee
Submittal Instructions
Mail this form and attachments to DARS/DHHS, P.O. Box 12306, Austin, Texas, 78711.
Office for Deaf and Hard of Hearing Services

4900 North Lamar, Suite 2169, Austin, Texas 78751

P.O. Box 12306, Austin, Texas 78711

(512) 407-3250 Voice or (512) 407-3251 TTY

www.dars.state.tx.us

DARS3901A (06/06)
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dhhs

2006-06-21

Health and Human Services

Deaf Services