ADA Request Form Notify Date request submitted:Person Needing AccommodationName:Are you:Select your roleDefendantLitigant/PartyWitnessJurorVictimContact Information for Person Needing AccommodationStreet or P.O. Box:Zip Code:City:Telephone Number:State:Select your stateAlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces Americas (except Canada)Armed Forces EuropeArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin Islands (U.S.)VirginiaWashingtonWest VirginiaWisconsinWyomingEmail Address:Person Making Request (If Other Than the Person Needing the Accommodation)Name:Email Address:Telephone Number:Relationship to person needing an accommodation:Case Information (If Applicable)Style of case (case title), if known:Judge, if known:Select JudgeJudge Steven R. WilsonJudge Katherine MishJudge Robert E. StoneHearing Officer Kameisha PresleyMagistrate Lindsay StrokeHearing Officer — VacantMagistrate Bruce BaillieMagistrate Adrienne FlemingMagistrate Kathryn HillJudge William WallaceJudge Robyn E. StoneJudge Darren SteeleJudge Kathleen H. RobertsJudge Lauren SweetJudge Nicole MenzJudge Daryl IsenhowerJudge Jeffrey W. HendriksJudge Edmond W. AlonzoJudge Rebecca WhiteJudge Michael D. PorterJudge William L. RobyJudge Anastasia M. NormanJudge Leatha D. MullinsJudge Michael J. LinnJudge Steven J. LevinJudge Victoria L. GriffinJudge Lillian EwenJudge Sherwood Bauer, Jr.Chief Judge Charles A. SchwabJudge Jennifer Alcorta WatersJudge Michael C. HeiseyJudge Robert MeadowsJudge Elizabeth MetzgerJudge Michael J. McNicholasJudge Cynthia L. CoxJudge Laurie E. BuchananCase number, if known:Date and time accommodation needed:Location (courthouse/courtroom) accommodation needed:Duration for which the modification is requested:Type of case, if known:Type of case, if known: appeal circuit criminal circuit civil family court probate, guardianship, or mental health county criminal county civil traffic court small claim other (please specify)Other Type of CaseType of proceeding, if known:Type of proceeding, if known: arraignment bond hearing hearing trial appellate oral argument other (please specify)Other Type of ProceedingAccommodations RequestedNature of disability that necessitates accommodation:Radio Field 1 Assistive listening device (Assistive listening systems work by increasing the loudness of sounds, minimizing background noise, reducing the effect of distance, and overriding poor acoustics. The listener uses a receiver with headphones or a neckloop to hear the speaker.) Communication access real-time translation/real-time transcription services (CART is a word-for-word speech-to-text interpreting service for people who need communication access. A rendering of everything said in the courtroom will appear on a computer screen. CART is not an official transcript of a court proceeding.) Sign Language Interpreter (Please specify American Sign Language, oral interpreter, signed English, or other type of signing system used by persons with hearing loss.)Signing SystemRadio Field 2 Assignment to a courtroom that is accessible to a person using a mobility device (Please specify wheelchair, scooter, walker, or other mobility device that is used.)Mobility DeviceRadio Field 3 Provision of court documents in an alternative format (Please specify Braille, large print, accessible electronic document, or other accessible format used by persons who are blind or have low vision.)Alternative FormatRadio Field 4 Other accommodation (please specify)Specify OtherSubmit Form
