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)



Enter the first date the accommodation is needed in MM/DD/YYYY format.
Enter the final date the accommodation is needed MM/DD/YYYY format.
Court location where accommodation is needed.
First name of person requesting the accommodation.
Middle name of person requesting the accommodation.
Last name of person requesting the accommodation.
Entered in (555) 555-5555 format.
What specific accommodation(s) are you requesting? Maximum characters allowed is 1000.
Please provide any additional information that might be useful in reviewing your accommodation request. Maximum characters allowed is 1000.