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Accommodation Request
Applicants Information
Applicant's Name:
Street Address:
Email Address:
Telephone Number:
Applicant is:
Name of Court or Court Program, Service or Activity Information
Street Address:
Mailing Address:
If Accomodation is for a Court Case, specify:
Case Name:
Case Number:
Request for Accommodations by Persons with Disability (and Response)
1. Type of proceeding or court service, activity or program:
2. Proceedings to be covered (e.g., trial, bail hearing, preliminary hearing, particular witness at trial, sentencing hearing, or other court service, program or activity):
3. Dates accommodations needed (specify):
4. Impairment necessitating accommodations (sepcify):
5. Type of accommodations requested (specify):
6. Special requests or anticipated problems (specify):
In addition to the basic application information Court Administration will need to better understand the nature of your disability and how it impacts your ability to actively participate in the court environment. Please provide documentation from appropriate medical or psychological personnel which identifies the disability and provides sufficient information regarding the limitations of the disability. This information will also assist the court in providing the appropriate accommodation in your matter.
Additional relevant documents should be emailed to Accommodation [email protected] or by Fax at 520-866-5401.

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