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ADA ACCOMMODATIONS REQUEST

Name

Street or P.O. Box

City

State/Zip code

Telephone Number (include area code)

Email Address

Name of Person making request (if other than the person needing the accommodation)

Telephone Number

Email

Relationship to person needing an accommodation

Case Number

Judge

Date Needed

Time Needed

Courtroom Number

Nature of disability that necessitates accommodation

Accommodation requested (please check one of the following six options)

Assistive listening device (Assistive listening systems work by increasing the loudness of sounds, minimizing background noise, reducing the effect of distance, and overriding poor acoustics. The listener uses a receiver with headphones or a neckloop to hear the speaker.)
Communication access real-time translation/real-time transcription services (CART is a word-for-word speech-to-text interpreting service for people who need communication access. A rendering of everything said in the courtroom will appear on a computer screen. CART is not an official transcript of a court proceeding.)
Sign Language Interpreter (Please specify American Sign Language, oral interpreter, signed English, or other type of signing system used by persons with hearing loss.)
Assignment to a courtroom that is accessible to a person using a mobility device (Please specify wheelchair, scooter, walker, or other mobility device that is used.)
Provision of court documents in an alternative format (Please specify Braille, large print, accessible electronic document, or other accessible format used by persons who are blind or have low vision.)
Other accommodation

If other accommodation(please specify)

Security Code

Enter the code shown above in the box below.

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ADA ACCOMMODATIONS REQUEST

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