6601 Ritchie Highway, DL-200 (06-23)
N.E. Glen Burnie, Maryland 21062
Application to Provide Interpretation and/or Translation Services
If you are an individual requesting placement on the Maryland Department of Transportation Motor Vehicle Administration’s (MVA)
Interpreter/Translator Listing to provide interpretation/translation services to MVA customers, you must complete and submit this
application and requested documents to: Motor Vehicle Administration, Driver Services, Room 210, 6601 Ritchie Highway, N.E.
Glen Burnie, MD 21062 or email - [email protected].
Please Note: If approved, your name will be added to the MDOT MVA’s provider listing of interpreters and/or translators and you
will be assigned an Interpreter number. You will use this number to confirm approval status during any MDOT MVA business.
Instructions:
All applicants must complete and submit all documents listed:
1. Complete and sign form “Application to Provide Interpretation and/or Translation Services.” (DL-200, Sections A through D)
2. Complete and sign “Interpreter and/or Translator Certification Form” (DL-201)
3. A photocopy of the applicant’s valid driver’s license or state identification card.
4. Two (2) written (legible and in English) letters of recommendation that state the language(s) that you interpret/translate and
your interpreting/translating ability, with contact information (name, phone number and email).
5. A photocopy of the applicant’s certification and/or contract. (Please see section C of this form for the detailed list. Subject for
approval by the Administration).
Section A - Applicant Information
First Name: Middle Initial: Last Name: Date of Birth:
Jorge E Torrealba Daza 09-04-1984
Cell Number: Business Number: Email:
8327747291 3463869262
[email protected]Street Address: City: County: State: Zip Code:
455 wildwood forest Dr Apt 6301 spring Montgomery TX 77380
License or ID Number: State of Issuance:
47760445 Texas
Section B - Certification and Permission to List Contact Information
“My signature certifies that I request to be listed as an eligible provider of interpretation and/or translation services for customers
of the MDOT 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 sufficient
grounds for rejection of this application and/or removal from the MDOT MVA’s Approved Interpreter/Translator Provider Listing.”
Digitally signed by: Jorge Torrealba [KLet]
Jorge Enrique Torrealba Daza DN: CN = Jorge Torrealba [KLet] email = [email protected] OU =
User Accounts, Enabled Users, Production, KOM, SLeT, Employees Accounts, IT
Date: 2024.01.25 12:48:57 -06'00'
01/25/2024
Printed Name of Applicant Signature Date
The MDOT MVA publishes and releases the “MVA’s Approved Interpreter/Translator Provider Listing” on the MDOT MVA website at
https://mva.maryland.gov/ and to the MVA Branch Offices.
We must have your permission to release your name, contact telephone number(s) and language(s) you provide.
“I hereby authorize the MDOT MVA to release my contact information on the “MVA’s Approved Interpreter/Translator
Provider Listing.”
Jorge Torrealba [KLet]
2024.01.25 12:50:02 -06'00'
Signature
For more information, please call: 410-768-7000 (to speak with a customer agent).
TTY for the hearing impaired: 1-800-492-4575. Visit our website at: www.MVA.Maryland.gov
Section C - Required Credentials
Applicants must have certification from an accredited professional interpreter and/or translator association or have completed an
interpreter and/or translator certification program approved by the administration. The listings below are the acceptable credentials
required by the administration:
• Currently listed on the State of Maryland’s Court Interpreter Registry
• Currently listed on the Federal or US Court Interpreter Registry
• “Active” membership status with ATA (American Translator Association) – Associate Membership is not acceptable. ATA card
must have the word “Active.” This card must be renewed and sent in every year to remain on the list.
• Current contract with Lion Bridge, Ad Astra or Language Line
• Certification of testing from “The Community Interpreter”
• Certification from a College and/or University for Interpreting and/or Translating
• Other Certification Program that administered testing of Interpretation/Translation skills (subject to approval by the Administration)
Section D - Provider Listing
Place a check mark for each county you are available to work in and whether you will be providing Interpreting, Translating, or both
services.
Note: Certification from Section C must indicate the language(s) you have been tested/certified to provide services for.
Applicant’s Name
Proficient Language(s)
Maryland County Available to
Interpreter Translator
Provide Services
Allegany
Anne Arundel
Baltimore City
Baltimore County
Calvert
Caroline
Carroll
Cecil
Charles
Dorchester
Frederick
Garrett
Harford
Howard
Kent
Montgomery
Prince George’s
Queen Anne’s
St. Mary’s
Somerset
Talbot
Washington
Wicomico
Worcester
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