funds to: STATE OF FLORIDA Please complete this form and return it with the proper remittance to: Court Interpreters Program, Office of the State Courts Administrator, Supreme Court B
Trang 1REGISTRATION FOR ORIENTATION WORKSHOP
FLORIDA STATE COURTS SYSTEM—COURT INTERPRETERS PROGRAM
Please make your cashier’s check/money order payable in U.S funds to:
STATE OF FLORIDA Please complete this form and return it with the proper remittance to:
Court Interpreters Program, Office of the State Courts Administrator, Supreme Court
Building, 500 South Duval Street, Tallahassee, FL 32399-1900
All registration forms and fees must be received by close of business on the registration deadline date (see
Schedule of Program Events for applicable deadlines) Postmarks are not accepted Fees are refundable up until
the closing date of registration Once the registration deadline expires, all fees are refundable and non-transferable, and no credits will be issued .
Every effort will be made to register you for the date(s) you request However, interested participants are encouraged to enroll at the earliest possible opportunity since space is limited As soon as your registration and payment are received, an e-mail notification will be sent to you Once the registration deadline expires, a formal written confirmation will be mailed to you at the address provided If for any reason your choice cannot be granted, you will be notified in writing and alternative dates/locations will be suggested
If you are a person with a disability who requires an accommodation to participate, please contact Court Interpreters
Program staff prior to the registration deadline at:
Phone: 850-922-5107 Fax: 850-414-1342 E-mail: interpreters@flcourts.org
Persons using a TDD may initiate contact through the Florida Relay Service, 711.
Please Print or Type:
State: County: Zip :
Cell Phone:
Mr./Mrs./Ms./Dr.:
(Circle One)
Mailing Address:
City:
Home Phone:
Fax Number:
Business Phone:
Social Security Number (Required):
E-Mail Address:
Languages in Which I Possess a Native-like Fluency (List All Applicable:)
ORIENTATION WORKSHOP
Orientation Dates (Option 1)
Location
(Option 2)
My payment for $ is enclosed Registration Fee: $150.00 (Florida Resident) $300.00 (Non-Resident)
Trang 2Court Interpreter Certification and Regulation Program (CICRP)
Criminal Background Check and Good Moral Character Evaluation
Acknowledgement
All applicants for registration and all applicants for CICRP pre-requisite events (orientation workshop, written examination, and oral performance examination) shall be of good moral character and shall be fit to perform the obligations and responsibilities of a spoken language court interpreter
Applicants for CICRP pre-requisite events acknowledge that upon application for registration, all applicants shall be subject to a fingerprint-based criminal background check according to standards prescribed by the Court Interpreter Certification Board (“Board”), and shall be subject
to a good moral character evaluation by the Board in accordance with rules 14.200(5), 14.300, and 14.405(b), Florida Rules for Certification and Regulation of Spoken Language Court Interpreters
Applicants for CICRP pre-requisite events are strongly encouraged to review the program rules thoroughly before proceeding with registration and payment for the pre-requisite events
The discovery of any past, present, or future conduct that reflects adversely on the character or fitness of an applicant may be cause for further inquiry by the CICRP staff and/or referral to the Board before approval is granted to attend CICRP said events.
No refunds shall be issued for pre-requisite events to registration applicants who are denied program admission based on the failure to pass the criminal background check and/or based on findings from the good moral character evaluation
Applicant's Printed Name:
Applicant's Signature: Date:
*** EXECUTION OF THIS DOCUMENT DOES NOT GUARANTEE CONFIRMATION OF
ATTENDANCE TO ANY PRE-REQUISITE EVENT***
Trang 3C OURT I NTERPRETER O RIENTATION P ROGRAM Florida Court Interpreter Certification and Regulation Program
Oath of Attendance Verification
Official photo identification is required to gain entry to all on-line orientation workshop activities You must submit, in advance, a valid form of identification to be granted login access to the Orientation Workshop These materials must be completed and received with your Registration Application Please note the email
address you detail on this form will be used as your login credential for the Orientation Workshop.
To complete this mandatory prerequisite:
1 complete the Oath of Attendance Verification;
2 send a copy of your government-issued photo identification; and
3 send all documents with your Registration Application
That identification document must:
• be government-issued (e.g., driver’s license or state-issued identification card, passport, U.S Military Identification Card, U.S Permanent Resident Card, National Identification Card or Consular
Identification Card);
• be current (not expired);
• contain both a current photo and your signature; and
• have a name written in the English alphabet that exactly matches the name used to register for the orientation workshop
The following items WILL NOT be accepted:
• a student ID (even from a public school, college or university)
• employee ID (even for government employees)
IMPORTANT – If you cannot provide the identification listed above, please contact program staff well in advance of
the submission deadline to arrange an alternative way to meet this requirement
Complete the general information Sign, date, and return with Registration Application materials by mail
I hereby swear and affirm that I am virtually attending the Florida Court Interpreter Orientation Program I further swear and affirm that the information below is true, accurate and that no relevant information has not been
omitted.
Full Name (First, Last):
Email Address:
Identification Type Submitted:
Signature:
Date:
Chose Identification Type