Mva Dl 200 Form – Fill Out and Use This PDF

	Maryland Counties		Type of Service
	Available to Provide
			Interpreter		Translator
Language(s) Proicient In:	Service To:
	Harford	q฀	q฀	฀	q
	Howard	q฀	q฀	฀	q
	Kent	q฀	q฀	฀	q
	Montgomery	q฀	q฀	฀	q
	Prince George’s	q฀	q฀	฀	q
	Queen Anne’s	q฀	q฀	฀	q
	St. Mary’s	q฀	q฀	฀	q
	Somerset	q฀	q฀	฀	q
	Talbot	q฀	q฀	฀	q
	Washington	q฀	q฀	฀	q
	Wicomico	q฀	q฀	฀	q
	Worcester	q฀	q฀	฀	q

MOTOR VEHICLE ADMINISTRATION

6601 Ritchie Highway, N.E.DL-200 (12-06) Glen Burnie, Maryland 21062

Application to Provide Interpretation and/or Translation Services

If you are an individual requesting placement on the Maryland Motor Vehicle Administration’s (MVA) listing as an approved interpreter and/or translator who is eligible to provide interpretation and/or translation services to MVA customers completing Driver Licensing and/or any other MVA transactions, you must complete and submit this application, requested documents, and the accompanying “Interpreter and/or Translator Certiication Form” (DL-201).

Please Note:

You will be notiied in writing if you have been approved or denied. If approved, your name will be added to the MVA’s provider listing of interpreters and/or translators. The MVA reserves the right to approve or deny this application or to remove an individual from the active Interpreter and/or Translator Provider Listing at any time.

Instructions:

All applicants must complete this application in it’s entirety. Be sure to submit the documentation required under Section B and a completed “Interpreter and/or Translator Certiication Form” (DL-201). Mail the forms and requested documents to the address listed below:

Maryland Motor Vehicle Administration, Driver Services, Room 207, 6601 Ritchie Highway, N.E., Glen Burnie, Maryland 21062.

(Please type or clearly print in blue or black ink)

Section A - Applicant Information

First, Middle, and Last Name

Provide one of the following: Your Driver’s License Number or State ID Card Number or Social Security Number

			and			or
		License or ID #		State of Issuance				Social Security #
	Date of Birth
	Home Phone				Business Phone
	Street Address (Home)			City			State	Zip Code

Applicants accepted must be a member of an accredited professional interpreter and/or translator association or have completed an interpreter and/or translator certification program. Please list each association’s name, address, contact number and a photocopy of your association membership card and/or certification.

Please list, on the accompanying Section C - Provider Listing, the languages in which you are proicient, the Maryland counties where you can provide service, and indicate whether you will provide interpretation and/or translation ser- vices in that language.

Section B - Certification/Instructions

This section must be completed and signed.

Certification

“My signature certiies that I request to be listed as an eligible provider of interpretation and/or translation services for customers of the MVA. I certify that all information provided on this application and accompanying documents is complete and true to the best of my knowledge. I authorize the MVA to contact, as necessary, all sources listed on this application and accompanying documents, to verify the information is true. I understand that any erroneous, misleading or fraudulent information is suficient grounds for rejection of this application and/or removal from the MVA’s Approved Interpreter/Translator Provider Listing.”

Signature of Applicant:

Printed Name:

Date:

Applicants for interpretation and/or translation service providers must submit the following documents with this completed application:

1.A photocopy of the applicant’s valid driver’s license or state identiication card or social security card.

2.Two written (legible and in English) letters of recommendation with contact information.

3.Completed and signed “Interpreter and/or Translator Certiication Form” (DL-201)

4.A photocopy of the applicant’s current membership card to an accredited professional association for interpreters and/or translators and/or a photocopy of a certiication of completion for interpretation and/or translation program.

5.Completed Section C of this application form.

Please Note: Upon receipt of your application, the MVA will make a determination regarding your request and you will be notiied in writing.

Mail completed forms and all required documents to:

Maryland Motor Vehicle Administration

Driver Services, Room 207 • 6601 Ritchie Highway, N.E. • Glen Burnie, Maryland 21062

Apply to...

Apply to register to vote with your driver’s license transaction. For details ask your customer service representative.

Instructions: All applicants must complete and submit Section C of this application. Please type or clearly print in blue or black ink the required information in the “Language(s) Proicient In” column and check boxes that apply in the other columns. Omission of required information may result in the rejection of this application.

Section C - Provider Listing

Applicant’s Name:

Application Date:

			Maryland Counties			Type of Service
			Available to Provide
						Interpreter		Translator
		Language(s) Proicient In:	Service To:
			Allegany	q฀		q฀	฀	q
			Anne Arundel	q฀		q฀	฀	q
			Baltimore County	q฀		q฀	฀	q
			Baltimore City	q฀		q฀	฀	q
			Calvert	q฀		q฀	฀	q
			Caroline	q฀		q฀	฀	q
			Carroll	q฀		q฀	฀	q
			Cecil	q฀		q฀	฀	q
			Charles	q฀		q฀	฀	q
			Dorchester	q฀		q฀	฀	q
			Frederick	q฀		q฀	฀	q
			Garrett	q฀		q฀	฀	q
Apply to...		Apply to register to vote with your driver’s license transaction. For details ask your customer service representative.