San Mateo — Interpreter Acknowledgment

Source: https://sanmateo.courts.ca.gov/system/files/local-forms/fcs-11.pdf

SUPERIOR COURT OF CALIFORNIA , COUNTY OF SAN MATEO Hall of Justice and Records 400 County Center, 6 th Floor Redwood City, CA 94063-1662 www.sanmateo.courts.ca.gov

CLERK OF THE COURT COURT EXECUTIVE OFFICER TEL. (650) 261-5080 CLERK & JURY COMMISSIONER FAX (650) 261-5142

INTERPRETER ACKNOWLEDGMENT

My presence in mediation is being requested by ___________________________________, to provide
interpretation.interpretation.interpretation.interpretation.interpretation.interpretation.interpretation.interpretation.interpretation.interpretation.interpretation.interpretation. (Name of client)

My signature indicates that I understand what my role is as an interpreter, and that I accept and will
follow the guidelines listed in the Interpreter Instructions, which are also summarized below:

1. Interpret only the exact words spoken by the person
2. Repeat everything that is said
3. Remain neutral
4. Maintain confidentiality
5. Not give advice or opinions
6. Tell the mediator immediately if there is a problem

Signature __________________________________________________ Date ____________________

Name (please print) ___________________________________________________________________

Address ____________________________________________________________________________

City _________________________________________ State _________ Zip Code ________________

Relationship to client(s) ________________________________________________________________

FCS-11 (Rev. 05/2026)