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Superior Court of Coconino County

LAP,

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Revised 10/2016

Superior Court of Coconino County

Language Access Plan (LAP)

I. Legal Basis and Purpose

This document serves as the plan for the Courts of Coconino County to provide to persons with

limited English proficiency (LEP) services that are in compliance with Title VI of the Civil

Rights Act of 1964 (42 U.S.C. 2000d et seq.; 45 C.F.R. § 80.1 et seq.; and 28 C.F.R. § 42.101–

42.112). The purpose of this plan is to provide a framework for the provision of timely and

reasonable language assistance to LEP persons who come in contact with Coconino County

Courts.

This language access plan (LAP) was developed to ensure meaningful access to court services

for persons with limited English proficiency. Although court interpreters are provided for

persons with a hearing loss, access services for them are covered under the Americans with

Disabilities Act rather than Title VI of the Civil Rights Act, and therefore will not be addressed

in this plan.

II. Needs Assessment

A. Statewide

The State of Arizona provides court services to a wide range of people, including those who

speak limited or no English. From a statewide perspective, the following languages were listed

with the greatest number of speakers who spoke English less than “Very Well” in Arizona

(according to the American Community Survey estimate report from the U.S. Census Bureau

dated April 2014):

1. Spanish

2. Navajo

3. Chinese

4. Vietnamese

B. Coconino County Courts

Coconino County Courts are responsible to provide services identified in this plan to all LEP

persons. However, the following list shows the languages that are most frequently used in this

court or the court’s geographic area.

1. Spanish

2. Mandarin

3. Navajo

4. Arabic

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LAP,

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5. Vietnamese

This information is based on data collected from court interpreter tracking in Coconino County

Courts and from the United States Census Bureau data for Arizona.

III. Language Assistance Resources

A. Interpreters Used in the Courtroom

1. Providing Interpreters in the Courtroom

In Coconino County Courts, court interpreters will be provided in all courtroom proceedings at no

cost to all LEP witnesses; litigants; victims; parents, guardians, and family members of minor

witnesses, victims, and/or litigants; as well as any other person whose presence or participation is

necessary or appropriate as determined by the judicial officer.

It is the responsibility of the private attorney, Public Defender or County Attorney to provide

qualified interpretation and translation services for witness interviews, pre-trial transcriptions

and translations and attorney/client communications during out of court proceedings.

2. Determining the Need for an Interpreter in the Courtroom

Coconino County Courts may determine whether a court customer has limited English

proficiency. Identification of language needs at the earliest point of contact is highly

recommended. The need for a court interpreter may be identified prior to a court proceeding by

the LEP person or on the LEP person’s behalf by counter staff, self-help center staff, family

court services, or outside justice partners such as adult and juvenile probation/parole officers,

attorneys, social workers, Victim/Witness Services or correctional facilities. Court staff and

outside justice partners will notify the court interpreter coordinator of the need for an interpreter

and the physical and electronic case file will reflect the need for an interpreter.

Signage throughout the court building indicating interpreter services are available may also help

to identify LEP individuals. Coconino County Courts will display signs at the Self Help Center

/Law Library desk, the Court Clerk’s Office, the window at the Justice Court counter and at the

main entrance.

The need for an interpreter also may be made known in the courtroom at the time of the

proceeding. In a case where the court is mandated to provide an interpreter, but one is not

available at the time of the proceeding, even after the court has made all reasonable efforts to

locate one, as previously outlined in this plan, the case will be postponed and continued on a date

when an interpreter can be provided.

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LAP,

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3. AOC Interpretation Resources

Court Interpreter Registry and Listserv

The AOC maintains a statewide roster of individuals who indicate they have interpreting

experience and have expressed interest in working in the courts. The court USING

INTERPRETING SERVICES will determine the competence of the persons listed. This roster is

available to court staff on the Internet at http://www.interpreters.courts.az.gov.

Additionally, AOC created a statewide listserv to allow courts to communicate via email on

court interpreter-related matters. The listserv is an excellent resource to locate referrals for

specific language needs. Access codes and instructions to join the listserv may be obtained from

the AOC Language Access contact person.

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Video Remote Interpreting (VRI)

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The AOC has installed video conferencing equipment at the State Courts building that will allow

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courts with compatible technology to remotely conference an interpreter from the Phoenix metro

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area or from another court jurisdiction into their court to improve resource allocation and reduce

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time and costs associated with interpreter travel. Contact the AOC LAP contact for more

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information on VRI connectivity and checklist for court proceedings most appropriate for video.

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B. Language Services Outside the Courtroom

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Coconino County Courts are also responsible for taking reasonable steps to ensure that LEP

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individuals have meaningful access to all court services and programs outside the courtroom.

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Court services and programs include but are not limited to self-help centers, clerk offices, intake

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officers, cashiers, and records room.

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1. Assistance to Understand Court Procedures and Policies

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Services offered by the court generally to English-speaking customers pursuant to the

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Employee Code of Conduct (ACJA §1-303) must also be provided to LEP litigants in their

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language.

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2. Assistance to Fill-out Court Forms and Pleadings

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Coconino County Courts will assist in the filling-out of court forms for those LEP court

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customers who are unable to do so either by themselves or with the assistance of another

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competent adult proficient in English and able to render assistance in a timely manner.

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Coconino County Courts will assist LEP customers in filling out forms to the same extent

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as anyone incapable of completing forms, such as for those with limited literacy skills or

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disabilities, in the following ways:

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An interpreter (in person or remotely) will interpret between a court staff person and the court

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customer. The court staff will transcribe verbatim the customer’s answers to form questions. The

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court staff person transcribing will not be the same person accepting the filing.

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A court staff interpreter will provide a complete and accurate English translation of the LEP

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person’s answers to form questions. Whenever possible, the interpreter translating the

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information on the form will not be the same interpreter assisting the LEP person in court during

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a hearing.

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The requirement that a form be filed may be waived, where appropriate. The LEP person will

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then be sworn in court and examined to create an oral record of what would otherwise have been

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filed in writing via the form. If necessary, that record can then be transcribed verbatim into the

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corresponding form fields.

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In all the above circumstances a notation will be added to the form indicating how the

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information on it was obtained, thereby allowing the creation of an oral record in open court

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confirming the form’s content matches the LEP person’s intended meaning.

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3. Court-ordered Services and Programs

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The courts also are responsible for taking reasonable steps to ensure that LEP individuals have

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meaningful access to all court-ordered services and programs. Court-ordered services and

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programs include but are not limited to conciliation, mediation, arbitration, treatment or

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educational programs provided by a court employee or a private vendor under contract with the

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court. Contracts with vendors that provide direct services to court users must include the

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requirement that the vendor provide language services, including interpreters, for all LEP

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individuals.

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The court uses the following resources to facilitate communication with LEP individuals and

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court staff or providers of court-ordered services:

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 Staff court interpreters and independent interpreter contractors;

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 Bilingual employees;

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 “I Speak” cards, to identify the individual’s primary language;

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 Telephonic interpreter services, (from Tele Interpreters)

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 Video remote interpreting services

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 The terms of the court’s contracts with providers of court-ordered services.

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To provide linguistically accessible services for LEP individuals, Coconino County Courts

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provide the following:

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 Workshops in English with interpreter services available in multiple languages on request

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regarding divorce & family court, co-parenting, guardianship, tenant/landlord issues,

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immigration, conservatorship

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 Bilingual family court services mediators for custody and visitation matters; and

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 Written informational and educational materials and instructions in Spanish

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 Self-help center services that include forms available in Spanish and assistance on request

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from staff and contract interpreters and telephonic services for multiple languages;

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 Bilingual mediators and interpreter support for family court mediators for custody and

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visitation matters

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 Spanish language forms on the Court website:

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http://www.coconino.az.gov/index.aspx?NID=1045

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 Website links from court’s website to the Supreme Court’s Spanish translated webpage

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for court forms and instructions and other language access related resources such as the

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court’s LAP and complaint form and process are available online.

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http://www.azcourts.gov/elcentrodeautoservicio/FormulariosdeAutoservicio.aspx

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C. Court Appointed or Supervised Personnel

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Coconino County Courts also shall ensure that court appointed or supervised personnel,

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including but not limited to child advocates, guardians ad litem, court psychologists and doctors

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provide language services, including interpreters as part of their service delivery system to LEP

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individuals.

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D. Translated Forms and Documents

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The Arizona courts understand the importance of translating forms and documents so that LEP

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individuals have greater access to the courts’ services. Coconino County Courts currently use

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forms and instructional materials translated into Spanish.

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The court has translated the following documents:

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 Terms and conditions of probation; and,

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 Several Civil, Traffic, Criminal and General forms available on the Flagstaff Justice

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 Court Website: http://www.coconino.az.gov/index.aspx?NID=1319

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 Translations of other forms as needed by court users.

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 Approximately 75 Self-Help forms (see Appendix A from Law Library).

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These documents are in the Self Help Center at 200 N. San Francisco St, Flagstaff, AZ and

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on the Courts website at: http://www.coconino.az.gov/index.aspx?NID=1045.

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Additional forms in Spanish may be found at the links to the Arizona Supreme Court and

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Maricopa County Superior Court provided on the Coconino County Courts website:

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http://www.azcourts.gov/selfservicecenter/Self-Service-Forms

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http://www.superiorcourt.maricopa.gov/Espanol/elCentroDeAutoServicio/SSC_formsSP.asp

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Protective Order forms may be found in multiple languages at:

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http://www.azcourts.gov/domesticviolencelaw/Protective-Order-Forms

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1. Sight Translation

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The court will provide assistance so LEP persons may understand court-issued documents

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provided in English through sight translation or other reasonable means. Qualified in-person or

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remote interpreters will provide sight translations of court documents and other documents

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associated with the case as possible at the counter or in hearings. Sight translation is appropriate

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for documents that are relatively short and uncomplicated, typically less than three

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pages. Documents that may not be appropriate for sight translation shall be submitted well in

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advance of the related hearing to the Office of the Court Interpreter.

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E. Websites/Online Access

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Coconino County Courts operates an Internet website and will ensure the website is accessible to

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LEP persons and will include, at a minimum:

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 A notice about the availability of language services written in Spanish and posted on the

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home page.

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 A hyperlink to Arizona Supreme Court’s Spanish-translated webpage at

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http://www.azcourts.gov/elcentrodeautoservicio

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 A hyperlink to the Maricopa County Superior Court Spanish translated website:

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http://www.superiorcourt.maricopa.gov/Espanol/index.asp

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IV. Court Staff and Volunteer Recruitment

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A. Recruitment of Bilingual Staff for Language Access

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Coconino County Courts are equal opportunity employers and recruit and hire bilingual staff to

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serve its LEP constituents. Primary examples include but are not limited to:

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 Court interpreters to serve as regular full-time or part-time employees or regular

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interpreter contractors of the court.

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 Bilingual staff to serve at public counters and or self-help centers; and

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 Bilingual staff available on call to assist with contacts from LEP individuals, as needed.

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B. Recruitment of Volunteers for Language Access

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The court also recruits and uses volunteers to assist with language access in the following areas:

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 In self-help centers, to assist LEP users;

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 At public counters to provide interpretive services between staff and the LEP public

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 The Coconino County Courts cooperate with Coconino Community College and

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Northern Arizona University to provide student interns to serve as language access

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volunteers in Spanish, Navajo and American Sign Language for out of court settings.

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V. Judicial and Staff Training:

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Coconino County Courts are committed to providing language access training opportunities for

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all judicial officers and staff members. Training and learning opportunities currently offered will

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be expanded or continued as needed. Those opportunities include:

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 Interpreter coordinator training;

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 Diversity Training;

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 Cultural competency training;

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 LAP training;

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 Staff attendance at non language specific language access training and Spanish and

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Navajo training, provided by the Arizona Court Interpreters Association, The Navajo

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Interpreters Association and other professional associations.

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 New employee orientation training; and,

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 Judicial officer orientation on the use of court interpreters and language competency.

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 AOC’s Language Access in the Courtroom Training DVD

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 AOC’s language access online training videos

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VI. Public Outreach and Education

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A. General

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To communicate with the court’s LEP constituents on various legal issues of importance to the

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community and to make them aware of services available to all language speakers, Coconino

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County Courts provide community outreach and education and seeks input from its LEP

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constituency to further improve services. Outreach and education efforts include:

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 Public service announcements in Spanish and Navajo, provided periodically through

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local media. Examples of the type of announcements include radio spot

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announcements on court access issues or on the availability of self-help center

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services; and,

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 Partnerships and collaborations with community associations to provide a court

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presence in the LEP community.

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 Free Legal Talks at the Coconino County Court Law Library sponsored by

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AZCourtHelp. Flyers promoting the talks are posted in the courts in Spanish.

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The court will solicit input from the LEP community and its representatives and will seek to

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inform community service organizations on how LEP individuals can access court services.

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B. Videos, Webinars, On-line Classes, In-person Classes and Other Similar

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Instructional Methods

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New public-facing videos designed to assist litigants or the public more broadly shall be in

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English and Spanish.

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Those videos, webinars, and instructional materials currently in existence which are deemed to

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be “vital” shall be made available in Spanish.

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The court will determine whether any existing videos, webinars, and instructional materials

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should be made available in languages other than English and Spanish by considering the

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Department of Justice’s four-factor analysis.

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VII. Formal Complaint Process

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If an LEP court customer believes meaningful access to the courts was not provided to them,

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they may choose to file a complaint with the trial court’s Language Access Plan Coordinator.

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The court will develop a complaint process that includes at a minimum, the following

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information:

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 The court will respond to any complaint within 30 days and the records will be

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maintained as public records.

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 The complaint may be filed as follows:

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The court customer should ask for the complaint form at the window of Justice

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Court or the Clerk’s Office. The customer can then submit the form to the Court

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Administrator who will decide if this complaint needs to be handled by the Court

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Interpreter Coordinator or other court staff.

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 The court has attached the complaint form (English/Spanish) to the LAP. In the

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alternative, the complaint forms may be located at: http://coconino.az.gov/index.aspx?nid=180

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 The court will ensure the translated versions of the complaint form are available in

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multiple locations, including, but not limited to:

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o Forms posted on the court’s website and

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o Hard copy forms available at public counters.

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Please see Appendix B for the complaint forms in various languages.

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VIII. Public Notification and Evaluation of LAP

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A. LAP Approval and Notification

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Coconino County Courts’s LAP is approved by the presiding judge and court executive officer.

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Upon approval, please forward a copy to the AOC Court Services Division. Any revisions to the

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plan will be submitted to the presiding judge and court executive officer for approval, and then

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forwarded to the AOC. Copies of Superior Court of COCONINO County’s LAP will be

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provided to the public on request and is available on the court’s website.

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B. Evaluation of the LAP

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Coconino County Courts will routinely assess whether changes to the LAP are needed. The plan

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Superior Court of Coconino County

LAP,

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may be changed or updated at any time but reviewed not less frequently than biennially.

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Every 2 years the court’s administrator and interpreter coordinator will review the effectiveness

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of the court’s LAP and update it as necessary. The evaluation will include identification of any

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problem areas and development of corrective action strategies. From time to time, the court may

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consider using a survey sampling of data collection for a limited time period, which involves

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assessing language access requests to assist in the evaluation of the LAP.

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Elements of the evaluation will include:

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 Number of LEP persons requesting a court interpreter or language assistance;

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 Assessment of current language needs to determine if additional services or translated

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materials should be provided;

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 Solicitation and review of feedback from LEP communities within the county;

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 Assessment of whether court staff adequately understand LEP policies and procedures

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and how to carry them out;

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 Review of feedback from court employee training sessions; and,

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 Customer satisfaction feedback as indicated on the access and fairness survey, if

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administered by the court during this time period.

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 Review any language access complaints received during this time period.

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C. Trial Court Language Access Plan Coordinator:

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Judith Costello, Court Interpreter/Coordinator

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Flagstaff Municipal Court

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15 N. Beaver St.

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Flagstaff, AZ 86001

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(928) 774-1401 x106 or (928) 853-8211

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jcostello@courts.az.gov

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D. AOC Language Access Contact:

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David Svoboda

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Court Services Division

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Administrative Office of the Courts

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1501 W. Washington Street, Suite 410

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Phoenix, AZ 85007

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(602) 452-3965, dsvoboda@courts.az.gov

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LAP,

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E. LAP Effective date: March 2017

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F. Approved by:

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Presiding Judge: [_______________] Date: [___________]

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Hon. Mark Moran

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Court Executive Officer: [_______________] Date: [___________]

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Gary Krcmarik

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Superior Court of Coconino County

LAP,

Page 1 of 2

Revised 10/2016

APPENDIX A 8

COCONINO COURTS 10

LEGAL FORMS AND INSTRUCTIONS 11

COCONINO COURTS LEGAL FORMS AND INSTRUCTIONS

PACKETS ONLINE: www.coconino.az.gov/lawlibrary

COCONINO COUNTY LAW LIBRARY AND SELF-HELP CENTER

Open 8-5, Closed weekends and holidays • 200 N. San Francisco St.,

Flagstaff, AZ 86001

928-679-7540 • 877-806-3187

Revised A

ugust 2016

FAMILY LAW

tarting a Case

Divorce

Legal Separation

Custody

Paternity: Both Parents Will Sign

Registering Another State’s Custody Order With Arizona

Annulment: Brief Information

esponding to a Divorce or Legal Separation

inishing a Case

Default

Consent Decree

A Response Was Filed: The Other Party Won’t Sign

Dismissing a Case

ediation, Counseling, and Family Evaluation

Asking for Family Court Services

Telling the Court That Family Court Services Could

Endanger You

emporary Custody, Parenting Time, or Child

Support

hanging or Stopping Court Orders

Changing Parenting Time and Child Support: But the

Children’s Residence Stays the Same

Changing Legal Decision-Making or the Percent of Time

the Children are at Each Household

Changing Child Support: Asking for the Change

Changing Child Support: Response

Changing or Stopping an Income Withholding Order

Changing or Stopping an Income Wittholding Order:

Response

nforcing Court Orders

Enforcing Child Support or Spousal Maintenance

Enforcing Parenting Time or Legal Decision-Making

Other Family Law Packets

Name Change

Representing Yourself in Court

Appearing at a Court Date by Phone

Moving a Court Date to a Later Date

Subpoena

Disclosure

Pre-Trial Statement

Settlement Conference Memorandum

Affidavit of Financial Information

Moving With Children

ETTING HELP WITH A FILING FEE

RDERS OF PROTECTION

GUARDIANSHIP, CONSERVATORSHIP, POWER

OF ATTORNEY

Getting Parental Control of Someone Else’s Child

Power of Attorney Over a Minor

Guardianship and/or Conservatorship

Investigator’s Report

Guardian’s Report

Renewing Inpatient Mental Health Care Authority

Conservator’s Accounting

Ending Power of Attorney Over a Minor

Ending Guardianship and/or Conservatorship

LANDLORD-TENANT

Tenant’s Rights and Responsibilities

Asking a Landlord to Fix Something

WSUITS

Suing Someone for More than $10,000

Civil Lawsuit in Superior Court: Answer

CRI

MINAL RECORDS

Restoring Civil Rights and/or Setting Aside a Felony

Setting Aside a Misdemeanor

SPUTING AN ITEM ON YOUR CREDIT

REPORT

COCONINO COURTS LEGAL FORMS AND INSTRUCTIONS

S PAQUETES EN LÍNEA: www.coconino.az.gov/lawlibrary

BIBLIOTECA LEGAL Y CENTRO DE AUTOAYUDA DEL CONDADO DE COCONINO

Abierto de 8 a 5, cerrado los fines de semana y días feriados • 200 N. San Francisco St.,

Flagstaff, AZ 86001

928-679-7540 • 877-806-3187

Revisado: August 2016

DERECHO FAMILIAR

ómo iniciar un caso

Divorcio

Separación legal

Custodia

Paternidad: Van a firmar ambos padres

Registrar la orden de custodia de otro estado en AZ

Anulación: Información breve

ómo responder en un caso de Divorcio o Separación

legal

ómo terminar un caso

Falta de comparecencia

Decreto de consentimiento

Se presentó una respuesta: La otra parte no quiere firmar

Cómo despedir un caso

ediación, Terapia, Evaluación familiar

Pedir servicios de la corte en asuntos familiares

Cómo decirle a la corte que los servicios de la corte en

asuntos familiares pueden ponerlo en peligro

Manutención o custodia de los hijos temporal

ómo cambiar o parar órdenes de la corte

Modificar el horario de crianza y la manutención de los

hijos: Sin cambiar el domicilio principal de los hijos

Modificar la responsabilidad legal para la toma de

decisiones o el porcentaje del tiempo que los hijos

pasan en cada hogar

Cómo cambiar la manutención de los hijos: Cómo pedir el

cambio

Cómo cambiar la manutención de los hijos: Respuesta

Cómo cambiar o suspender una Orden de retención de

ingresos

Cómo cambiar o suspender una Orden de retención de

ingresos: Respuesta

ómo hacer cumplir órdenes de la corte

Cómo hacer cumplir la manutención de los hijos o la

manutención del cónyuge

Aplicación del horario de crianza o de la responsabilidad

legal para la toma de decisiones

Otros paquetes de derecho familiar

El Cambio de nombre

Cómo comparecer ante el tribunal sin abogado

Cómo comparecer ante la corte por teléfono

Cómo postergar una audiencia de la corte

Orden de comparecencia

Divulgación

Declaración previa al juicio

Informe para la audiencia de conciliación

Declaración jurada de información financiera

Hacer una mudanza con los hijos

ISTENCIA CON UNA CUOTA DE LA CORTE

RDEN DE PROTECCIÓN

UTELAS, CURADURÍAS, Y PODERES LEGALES

Control paterno de un menor de edad por una persona que

no es su padre o madre

Poder notarial: De un menor de edad

Tutela y/o curaduría

Informe del tutor

Cómo renovar la autoridad de internación en un

establecimiento de salud mental

Contabilidad del curador

Cómo dar por terminado un poder legal: Sobre un menor

de edad

Cómo dar por terminada la tutela y/o curaduría

PROPIETARIO-INQUILINO

Derechos y responsabilidades de los inquilinos

Cómo pedirle al propietario que arregle algo

MANDA CIVIL

Demanda civil: La demanda es de un mínimo de $10,000

Demanda civil de la corte superior: Respuesta

NTECEDENTES PENALES

Cómo restaurar los derechos civiles y/o dejar sin efecto

un delito mayor

Anular un fallo de delito menor

DEMANDA POR UNA SITUACION EN SU

REPORTE DE CREDITO

Superior Court of Coconino County

LAP,

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APPENDIX B 18

LANGUAGE ACCESS COMPLAINT FORMS 20

GLISH 22

SPANISH 23

ARABIC 24

MANDARIN (CHINESE) 25

VIETNAMESE

Section 601 of Title VI of the Civil Rights Act of 1964, 42 U.S.C. 2000d states that “No person in the United States shall, on the ground

of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any

program or activity receiving federal financial assistance.”

Page 1 of 1 AOC GNGF1F

______________________________________________________________

(Court Name)

Language Access to Court Services Complaint Form

The court may be required to provide interpreters at no cost for court users, including litigants, victims, and witnesses who do not speak

English as their primary language and who have a limited ability to read, speak, write or understand English. If you believe you have not

been provided effective language assistance for any court or probation proceeding or other service provided by the court, please complete

this form and return it to: ____________________________________________________________

(Address of Court)

The submission of a complaint will NOT affect the outcome of any court matter.

The court will address your concerns within a reasonable time not exceeding 30 days after submission of this form.

THIS FORM IS AVAILABLE IN OTHER LANGUAGES UPON REQUEST.

PLEASE COMPLETE:

Today’s Date: _______________________________

First Name: ________________________________________

Last Name: _________________________________________

Address: __________________________________________

City/State/Zip: _____________________ /____ / ___________

Home Telephone: (________) _________ - ______________

Mobile Phone: (________) _________ - ______________

Email Address:

_____________________________________________________________________________________

Primary Language:

_____________________________________________________________________________________

Date of Incident:

_________________________________

What problem did you have with language assistance?

☐ The court did not provide an interpreter

☐ The interpreter did not interpret correctly or did not speak my language

☐ Other- please describe:

La fracción 601 del Título VI de la Ley de Derechos Civiles de 1964, 42 U.S.C. 2000d reza lo siguiente: “A ninguna persona presente en los Estados

Unidos se le privará del derecho de participar, ni se le negarán beneficios, ni estará sujeta a la discriminación debido a su raza, etnia u origen, de

ningún programa o actividad que reciba fondos federales.”

Language Access Complaint Form Page 1 of 1 AOCGNGF1FS

______________________________________________________________

(Nombre del Tribunal)

FORMULARIO DE QUEJA

Servicios de Traducción e Interpretación

Para garantizar la participación en las diligencias y los servicios judiciales, se le proveerá un intérprete sin costo alguno a las personas

tales como litigantes, víctimas, ofendidos y testigos que no hablen el inglés como idioma principal o a aquellos que no sepan escribir,

leer, entender o hablar el inglés. Si Ud. cree que no le han facilitado servicios de interpretación en el tribunal, o para gozar de los

servicios de régimen a prueba, por favor, llene este formulario y envíelo a: _______________________________

Ninguna causa pendiente se verá afectada por haber sometido una queja.

Este tribunal tratará de abordar su queja en un plazo de 30 días después de haberla sometido.

PUEDE OBTENER ESTE FORMULARIO EN OTROS IDIOMAS SI LO SOLICITA

LLENE LOS ESPACIOS EN BLANCO:

Fecha: _______________________________

Nombre: __________________________________________

Apellido(s): _________________________________________

Dirección: _________________________________________

Ciudad/Estado/C.P.: _________________ /____ / ___________

Teléfono: (________) _________ - ______________

Celular: (________) _________ - ______________

Correo electrónico:

_____________________________________________________________________________________

Idioma principal:

_____________________________________________________________________________________

¿En qué fecha sucedió el incidente?

_________________________________

Explique cuál fue el problema:

☐ El tribunal no me proporcionó un intérprete

☐ El intérprete no interpretó de manera adecuada o no hablaba mi idioma.

☐ Otro motivo; anote los detalles:



 . "

Language Access Complaint Form AOC GNGF1FA

______________________________________________________________









:

_________________________________________________________________________________________________________________



. 

: 



: 

 : _______________________________

 : ________________________________________

 : _________________________________________

 : __________________________________________

 : __________ /____ / ___________

 : (________) _________ - ______________

 : (________) _________ - ______________

 :

_____________________________________________________________________________________

 :

_____________________________________________________________________________________

 :

_________________________________



 ☐

 ☐

 ☐

1964 年的民权法案,第六章第 601 段 42 U.S.C.2000d 规定,“在美国,没有人可以基于种族,肤色或原有国籍的理由,在联邦政

府经济支援的项目或活动中,被排除参与,或被拒绝接受得到福利,或于活动中受到歧视.”

Language Access Complaint Form Page 1 of 1 AOCGNGF1FC

______________________________________________________________

(

法庭名称

)

对法庭所提供其他语言(非英语)翻译服务不满意投诉表格

法庭有必须为当事人,受害者和证人等不说英语为第一语言的民众,或者在阅读,口讲,书写或理解英语能

力有限的民众,提供免费翻译服务.如果你认为你在任何法庭事务或缓刑诉讼过程中,未曾接受到有效的

语言协助,请填写此投诉表格并提交(下面法庭地址)：

____________________________________________________________

(

法庭地址

)

提交此投诉表格,于任何正在法庭处理的事务,对其结果不具任何影响

法庭将于此表格提交后一段合理的时间内,但不会超过 30 天,处理你的顾虑

此表格可按要求于其他语言提供

请填好:

今天日期: __________________________

名: ___________________________________

姓: ___________________________________________

地址: __________________________________

城市/州/邮编______________ /_____ / ____________

住宅电话号码: (________) _________ - _______

移动电话号码: (________) _________ - ____________

电子邮件:

__________________________________________________________________________________

第一语言:

__________________________________________________________________________________

事故日期:

_________________________________

你遇到了些什么有关语言辅助的问题?

☐ 法庭没有提供翻译员

☐ 翻译员的翻译不正确或不说我的语言

☐ 其他- 请说明:

Mục 601 của Tiêu Đề VI, Đạo Luật Dân Quyền năm 1964, 42 U.S.C. 2000d quy định: “Không người nào ở Hoa Kỳ không được tham gia, bị từ chối

quyền lợi, hoặc bị phân biệt đối xử theo bất kỳ chương trình hoặc hoạt động nào nhận hỗ trợ tài chính từ liên bang trên cơ sở chủng tộc, màu da

hoặc nguồn gốc quốc gia.”

Language Access Complaint Form Page 1 of 1 AOC GNGF1FV

______________________________________________________________

(Tên Ta n)

Mu Đơn Khiu Ni v Vic Tip Cn Ngôn Ng cho Dch V Ta n

Ta n c th được yêu cầu phi cung cp cc thông dch viên min ph cho nhng ngưi s dng dch v của

ta n/[nhng ngưi tham gia phiên toà], bao gm các đương s, nn nhân v nhân chng không ni Ting

Anh như l ngôn ng chnh của h v l nhng ngưi b hn ch kh năng nghe, nói, đc, vit hoc hiu Ting

Anh. Nu qu v tin rng qu v chưa được cung cp dch v h trợ ngôn ng hiu qu  bt k thủ tc tố tng

nào của ta n, qun ch hoc dch v khc được ta n cung cp, vui lng hon thnh đơn ny v gi li

cho:____________________________________________________

(Đa Ch ca Ta n)

Vic np đơn khiu ni s KHÔNG nh hưng đn kt qu ca bất kỳ vấn đ no đưc gii quyt ti ta n.

Ta n s gii quyt cc vấn đ quan ngi ca qu v trong khong thi gian hp l không qu 30 ngy sau khi

np đơn ny.

ĐƠN NY ĐƯC CUNG CP BNG CC NGÔN NG KHC THEO YÊU CU.

VUI LÒNG ĐIỀN ĐẦY ĐỦ THÔNG TIN:

Ngy Hôm Nay: ____________________________

Tên: _____________________________________

H: _______________________________________

Đa Ch: __________________________________

Thnh Phố/Tiu Bang/Zip: ____________ /____ / ___

Số Đin Thoi Nh: (______) ______ - ________

Số Đin Thoi Di Đng: (______) ______ - _______

Đa Ch Email:

__________________________________________________________________

Ngôn Ng Chnh:

__________________________________________________________________

Ngy Xy Ra S Vic:

_________________________________

Qu v gp vn đ g vi vic h trợ ngôn ng?

☐ Ta n không cung cp thông dch viên

☐ Thông dch viên không thông dch chnh xc hoc không ni ngôn ng của tôi

☐ Vn đ Khc - vui lng nêu r:

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