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.

If you have questions, please contact the ADA Contact specific to your court location.

Should you wish to submit a paper copy instead, please download the Printable ADA Accommodation Request Form (PDF form)

First date needed (required):

Enter the first date the accommodation is needed in MM/DD/YYYY format.

Last date needed (required):

Enter the final date the accommodation is needed MM/DD/YYYY format.

Court location (required):

Court location where accommodation is needed.

Case name or court file number (if known):

First name (required):

First name of person requesting the accommodation.

Middle name:

Middle name of person requesting the accommodation.

Last name:

Last name of person requesting the accommodation.

Street address 1 (required):

Street address 2:

City (required):

State (required):

Postal code (required):

Email address (required):

Retype email address (required):

Phone number:

Entered in 555-555-5555 format.

Person is (required):

Type of case (required):

Accommodation(s) requested (required):

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.

Who is completing this form? (required):

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