Fillable ADA Accomodation Appeal Form (NJ Judiciary)

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ADA Accomodation Appeal Form (NJ Judiciary)

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Revised: 07/15/2011, CN: 11507 page 1 of 2
New Jersey Judiciary
Americans with Disabilities Act
Accommodation Appeal Form
for Court Users
Contact Information
Last Name
First Name
Address
City
State
Zip Code
Telephone Number(s)
Date
Home Number:
Daytime Number:
Alternate Contact
Last Name
First Name
Address
City
State
Zip Code
Telephone Number(s)
Home Number:
Daytime Number:
Appeal Information
Where were you seeking
an accommodation:
Supreme
Court
Appellate
Division
Tax
Court
Municipal
Court
Superior Court
(County or Local Court)
Other
Court / Division / Unit
Location (City / County)
Print Form
Clear Form
Revised: 07/15/2011, CN: 11507 page 2 of 2
Americans with Disabilities Act --Accommodation Appeal Form (Continued)
Description of Appeal
Please describe your request for an accommodation and why you believe you have
been denied an effective ADA accommodation to access and/or participate in any
court proceeding, judiciary program, service, or activity. Please provide date(s),
time(s) and place(s) of event(s), and include name(s) or title(s) of any judiciary
employees involved. Please also provide names, addresses, and telephone
numbers of any witnesses. Please attach additional pages if necessary and sign
and date those pages.
Signature:
Date:
If you need help completing this form, please contact the local Title II ADA
coordinator. Please return this completed form to the local Title II ADA
coordinator. Name and contact information for the local Title II ADA
coordinators can be found in the Judiciary Title II ADA procedures for access to
the courts by individuals with disabilities brochure or at njcourts.com.
The Judiciary will provide a reasonable accommodation for court users with a
disability, enabling them to access and participate in court proceedings, programs,
services and activities, provided that the accommodation does not fundamentally
alter the nature of a judiciary program, service, or activity or impose an undue
hardship upon the Judiciary.
NOTE: You have the right to pursue whatever remedies are available under state
law (New Jersey Division on Civil Rights) and federal law (U.S. Department of
Justice). You should be aware that there are time limits for filing claims with
outside agencies. Check with the outside agency for its filing deadlines.
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ADA Accomodation Appeal Form (NJ Judiciary)

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Completed 21 July 2020

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