Free Application for Wisconsin Interpreting and Transliterating Assessment - Wisconsin

DEPARTMENT OF HEALTH SERVICES Division of Long Term Care F-22640 (07/2008)

STATE OF WISCONSIN

APPLICATION FOR WISCONSIN INTERPRETING AND TRANSLITERATING ASSESSMENT (WITA)
Name ­ Applicant (Last, First, MI) Address (Street, PO Box) Address (City, State, Zip Code) County of Residence Email Address Telephone Number (Home) Telephone Number (Work) Telephone Number (Cell)

Written Exam OR Performance Assessment--If you checked "Performance Assessment," please enclose proof of passing the WITA Written Exam within the past year or Registry of Interpreters for the Deaf (RID) Generalist Written Exam within the past five years. Preferred Test Date Office for Deaf and Hard of Hearing (ODHH) Regional Office

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The fee for the Written Exam is $30, which can only be paid with a cashier's check or money order. Personal checks or cash will not be accepted. Application fees are non-refundable. The written exam is offered until June 2008. Starting July 1st, only RID-NIC written exam will be accepted. The fee for the Performance Assessment is $150, which can only be paid with a cashier's check or money order. Personal checks or cash will not be accepted. Application fees are non-refundable. Mail your application and fee to the ODHH Regional Office that you prefer at least three weeks before the test date. Applications are processed on a first-come, first-serve basis. An assessment slot WILL NOT be assigned until payment is received. There will be no exceptions to this policy.

ODHH--Western Regional Office 610 Gibson Street, Suite 1 Eau Claire, WI 54701 ODHH--Northern Regional Office 1000 Lakeview Dr Wausau, WI 54401

ODHH--Northeastern Regional Office 555 Country Club Road Green Bay, WI 54313-4908 ODHH--Southeastern Regional Office 141 Northwest Barstow Street, Room 104 Waukesha, WI 53188-3789

ODHH--Southern Region 1 West Wilson Street, Room 451 PO Box 7851 Madison, WI 53707-7851