ADA Accommodation Request Form

All fields are required.

Type of Accommodation

Choose accommodation type:

If "Other" is chosen, please specify:

Party Requesting Assistance

Last Name:

First Name:

Phone:

Email:

If "Other" is chosen, please specify:

Date & Time Assistance is Needed

Date:

Time:

Case Information

Case Number:

Type of Event:

If "Other" is chosen, please specify:

Location of Appearance

Choose One:

Courtroom Number:

Presiding Judge

Name of Judge (if known):

Other information

If you're requesting assistance for someone else, please provide your contact information:

Last Name:

First Name:

Phone:

Email: