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Court: Request for Accommodations

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Steps

1. Step One This section is complete This section is incomplete
2. Step Two This section is complete This section is incomplete

Step One

You should request accommodations as far as possible in advance of your court appearance or other court activity. To request accommodations, complete this form and submit this form online or appear at the court to request a form. If you need help completing this form, contact the ADA Coordinator Deanna Warunek at 734-374-1338. To properly evaluate your request, the court may ask you for more information.
The ADA Coordinator will respond to your request before the court appearance or other court activity. If your request is denied, you may request a review in accordance with the court's local administrative order. At your request, the court will provide you a copy of the local administrative order.
Today's Date
Today's Date
Applicant Is
1. Witness
2. Juror
3. Attorney
1. Party
2. Other (Specify)
Case Name and Number (if applicable)
Name
Email Address
Address
City
State
Zip Code
Phone Number
1. What type of proceeding or court service, activity, or program are you attending (i.e., hearing, jury duty, mediation meeting, trial)?
2. On what dates do you need accommodations?
3. For what impairment do you need accommodations (for a sign language interpreter, specify ASL, CDI, or CART)?
4. What type of accommodations do you need?
Continue

Step Two

The request has been
1. Granted
2. Denied
For the above matter or appearance, from
For the above matter or appearance, from Start Date
—
For the above matter or appearance, from End Date
in whole as follows: (Specify the accommodations)
in part. As consented to by the applicant, alternative accommodations are as follows: (Specify the accommodations)
The request is DENIED because
1. the applicant is not a qualified individual with a disability under the ADA
2. the request creates and undue financial or administrative burdon on the court (as defined by the ADA)
3. the request fundamentally alters the nature of the service, program, or activity (as defined by the ADA)
The basic for this denial is: (specify on separate sheet if needed. Include alternative accommodations offered but rejected by the applicant)
The applicant was notified of the court's response
1. By phone
2. By mail
3. By email
4. In person
Date of Response
Date of Response
Name of Respondee
Court Name and Address
Phone Number of ADA Coordinator