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ACSF Distro Demo
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Aksè nan Sèvis nan Lang Ou: Fòm pou Fè Plent
Règleman Eta New York se pou fè etap rezonab pou metrize baryè lang pou sèvis ak pwogram piblik yo. Pou fè sa, objektif nou se pou: 1) Pale avèk ou nan lang ou epi 2) Ba ou fòm ak dokiman enpòtan pami sis (6) premye yo, pi souvan lang yo itilize, anplis lang Angle. Kòmantè ou sou fòm sa a ap ede nou reyalize objektif sa a. Tout enfòmasyon yo rete an sekrè.
Moun k ap fè plent lan
# ID Moun ki Fè Plent lan (si li gen youn)
Prenon
Non fanmi
Adrès ri
Gran Vil, Ti Vil oswa Vilaj
Eta
Kòd postal
Langaj ou pito
Imèl (sou genyen)
Nimewo Telefòn Kay
Lòt telefòn
Èske yon lòt moun ede ou fè plent sa a?
Wi
Non
Si se ‘Wi’, mete:
Prenon li
Non fanmi li
Kite pwoblèm ki te genyen? Koche tout kaz ki aplike yo, epi bay eksplikasyon anba la a.
Yo pa t ban mwen yon entèprèt
Mwen te mande yon entèprèt epi yo te refize ban mwen youn
Konpetans entèprèt la (yo) oswa tradiktè a (yo) pa t bon (Bay non yo, si ou konnen yo)
Entèprèt la (yo) te fè kòmantè gwosye oswa ki pa t apwopriye
Sèvis yo te pran twòp tan (Eksplike anba la a)
Yo pa t ban mwen fòm oswa avi nan yon lang mwen kapab konprann (bay dokiman ki nesesè yo anba la a)
Mwen pa t kapab itilize sèvis, pwogram oswa aktivite yo (Eksplike anba la a)
Lòt (Eksplike anba la)
Kilè te gen pwoblèm nan?
Dat
Lè
Ki kote ki te gen pwoblèm nan?
Dekri sa ki te pase a. Tanpri pa ekri twòp bagay. Itilize paj siplemantè si li nesesè. Ekri non ou an lèt detache sou chak fèy. Bay lang, sèvis ak dokiman ki nesesè yo. Mete non, adrès ak nimewo telefòn moun ki konsène yo, si ou konnen yo.
Èske ou te pote plent ba nenpòt moun nan Depatman/Ajans lan? Kimoun ak ki repons ou te jwenn? Tanpri pa ekri twòp bagay.
Mwen konfime deklarasyon sa a vrè dapre tout sa mwen konnen ak kwè.
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