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ADA Accommodation Request Form

Please fill out the electronic form below to request an accommodation under the Americans with Disabilities Act (ADA). It is recommended that you submit your completed form at least 10 business days prior to the date you need your accommodation, if at all possible. All requests for accommodation will be given due consideration and if necessary, may require an interactive process between the requester and the court to determine the best course of action.

You may also request that a copy of the information submitted be sent to you via email by checking the appropriate box below.

Applicant Is

Select an applicant type.

Name

First

Last

Address

Street

City

State

Zip

Phone Number

Type in your phone number (###-###-####).

Email Address

Confirm

Location

Name of court or court program, service, or activity for which the accommodation is being requested.

Case Name

Please provide a case name if applicable.

Case Number

Reason for Visit

Examples: Argument before the Supreme Court, Argument before the Court of Appeals, Division One, Meeting of a Board/Commission/Task Force, Filing Documents.

Start Date of Accommodations Needed

Enter or select the first date the accommodation is needed.

End Date of Accommodations Needed

Enter or select the final date the accommodation is needed.

Accommodations Requested

What specific accommodation(s) are you requesting? Maximum characters allowed is 1000.

Additional Information

Please provide any additional information that might be useful in reviewing your accommodation request. Maximum characters allowed is 1000.

Would you like someone to contact you about this matter?

Yes

Preferred Contact Method

Email
Phone

Who is completing this form?

Form completed by the requester
Form completed by someone other than the requester

Disclaimer

In addition to the basic application information, the ADA Office may need to better understand the nature of your disability and how it impacts your ability to actively participate in the court environment. We reserve the right to request documentation from the appropriate medical or psychological provider that identifies your disability and provides sufficient information regarding the limitations of the disability. This information will also assist the court to provide you with the appropriate accommodation.

Enter the code shown above in the box below.

ADA Accommodation Request Form

Applicant Information

Accommodation Information