Fillable ADA Model Request Form (Florida)

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ADA Model Request Form (Florida)

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FLORIDA STATE COURTS SYSTEM
ADA TITLE II ACCOMMODATION REQUEST FORM
1
June 10, 2010
RIGHT TO AN ACCOMMODATION
If you are an individual with a disability who needs an accommodation in order to participate in
a court proceeding or other court service, program, or activity, you are entitled, at no cost to
you, to the provision of certain assistance. Requests for accommodations may be presented on
this form, in another written format, or orally. Please complete the attached form and return it
to [identify applicable court personnel by name, address, telephone number, fax number, and
email address] as far in advance as possible, but preferably at least seven (7) days before your
scheduled court appearance or other court activity.
Upon request by a qualified individual with a disability, this document will be made
available in an alternate format. If you need assistance in completing this form due
to your disability, or to request this document in an alternate format, please contact
[insert name and contact information for the appropriate court ADA coordinator].
ADA ACCOMMODATIONS PROVIDED BY FLORIDA COURTS
Pursuant to Title II of the Americans with Disabilities Act the Florida State Courts System will
make reasonable modifications in policies, practices, and procedures; furnish auxiliary aids and
services; and afford program accessibility through the provision of accessible facilities, the
relocation of services or programs, or the provision of services at alternative sites, as
appropriate and necessary.
Examples of auxiliary aids or services that the State Courts System may provide for qualified
individuals with disabilities include:
Assistive listening devices
Qualified ASL or other types of interpreters for persons with hearing loss
Communication access real-time translation / Real-time transcription services
Accessible formats such as large print, Braille, electronic document, or audio tapes
Qualified readers
1
This form was developed for use by individuals with disabilities who may require a
modification in a policy, provision of an auxiliary aid or service, or assignment to an accessible
location in order to participate in a court proceeding or other court service, program, or activity
that is covered by Title II of the Americans with Disabilities Act. Court employees with
disabilities who need a reasonable accommodation to be able to perform the essential
functions of their jobs should contact their immediate supervisor, the ADA coordinator for their
court, the OSCA Office of Personnel Services, or the State Courts ADA Coordinator.
Florida State Courts System Page 2 ADA Accommodation Request Form
Accommodations that are granted by the state courts are made at no cost to qualified
individuals with disabilities.
2
AIDS/SERVICES COURTS CANNOT ADMINISTRATIVELY GRANT AS ADA
ACCOMMODATIONS
Examples of aids or services the Florida State Courts System cannot provide as an
accommodation under Title II of the Americans with Disabilities Act include:
Transportation to and from the courthouse
Legal counsel or advice
An official transcript of a court proceeding
Personal devices such as wheelchairs, hearing aids, or prescription eyeglasses
Personal services such as medical or attendant care
Readers for personal use or study
Additionally, the courts cannot administratively grant, as an ADA accommodation, requests that
impact court procedures within a specific case. Requests for an extension of time, a change of
venue, or participation in court proceedings by telephone or videoconferencing must be
submitted by written motion to the presiding judge as part of the case. The judge may consider
an individual’s disability, along with other relevant factors, in granting or denying the motion.
Furthermore, the court cannot exceed the law in granting a request for an accommodation. For
example, the court cannot extend the statute of limitations for filing an action because
someone claims that he or she could not make it to the court on time due to a disability, nor
can the court modify the terms of agreements among parties as an ADA accommodation.
Finally, the Americans with Disabilities Act (ADA) does not require the court system to take any
action that would fundamentally alter the nature of court programs, services, or activities, or
that would impose an undue financial or administrative burden on the courts.
2
Please note that providing accommodations for some individuals with disabilities who appear
in the courtroom as part of their employment duties or professional practice is a responsibility
that appropriately may be shared by the individual’s employer and the courts. Title I of the
Americans with Disabilities Act requires employers of 15 or more employees and Title II of the
Americans with Disabilities Act requires all state and local government employers to provide
reasonable accommodations to qualified employees with disabilities. In addition, Section 504
of the Rehabilitation Act of 1973, as amended, covers recipients of federal funding, and
requires all covered organizations to provide accommodations for their employees. These
responsibilities are concomitant with the courts’ responsibility under Title II of the ADA. It is to
everyone’s benefit when employers and the court system work together to ensure that
reasonable accommodations for individuals with disabilities are provided in the most efficient
and cost effective manner.
Florida State Courts System Page 3 ADA Accommodation Request Form
DOCUMENTATION OF THE NEED FOR AUXILIARY AIDS AND SERVICES
If an individual has a disability that is not obvious, or when it is not readily apparent how a
requested accommodation relates to an individual’s impairment, it may be necessary for the
court to require the individual to provide documentation from a qualified health care provider
in order for the court to fully and fairly evaluate the accommodation request. These
information requests will be limited to documentation that (a) establishes the existence of a
disability; (b) identifies the individual’s functional limitations; and (c) describes how the
requested accommodation addresses those limitations. Any cost to obtain such documentation
is the obligation of the person requesting the accommodation.
Florida State Courts System Page 4 ADA Accommodation Request Form
FLORIDA STATE COURTS SYSTEM TITLE II ADA ACCOMMODATION REQUEST FORM
Please return this completed form to [insert name, address, phone number, fax number,
and email address] as far in advance as possible, but preferably at least seven (7) days
before your scheduled court appearance or other court activity.
1. Date request submitted: ______/______/______
2. Person needing accommodation
Name: _________________________________________________________________
Are you (please check one of the following seven options):
[ ] Defendant [ ] Litigant/Party [ ] Witness [ ] Juror [ ] Victim [ ] Attorney
[ ] Other (please specify): __________________________________________________
3. Contact information for person needing accommodation
Street or P.O. Box: ________________________________________________________
City: ___________________________________________________________________
State: ___________________________________ Zip Code: _____________________
Telephone Number (include area code): ______________________________________
Email Address: ___________________________________________________________
4. Person making request (if other than the person needing the accommodation)
Name: _________________________________________________________________
Telephone Number (include area code): ______________________________________
Email Address: __________________________________________________________
Relationship to person needing an accommodation: ____________________________
5. Case information (if applicable)
Style of case (case title), if known: __________________________________________
Case number, if known: __________________________________________________
Judge, if known: ________________________________________________________
Date accommodation needed: ______________________________________________
Time accommodation needed: ______________________________________________
Location (courthouse/courtroom) accommodation needed: _______________________
Duration for which the accommodation is requested: ____________________________
Type of case, if known (please check one of the following ten options):
[ ] appeal [ ] circuit criminal [ ] circuit civil [ ] family court
Florida State Courts System Page 5 ADA Accommodation Request Form
[ ] probate, guardianship, or mental health [ ] county criminal [ ] county civil
[ ] traffic court [ ] small claim [ ] other (please specify) ____________________
Type of proceeding, if known (please check one of the following six options):
[ ] arraignment [ ] bond hearing [ ] hearing [ ] trial [ ] appellate oral argument
[ ] other (please specify) __________________________________________________
6. Accommodations requested
Nature of disability that necessitates accommodation: ___________________________
________________________________________________________________________
Accommodation requested (please check one of the following six options):
[ ] 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.):_______________________________________________________
___________________________________________________________________
[ ] 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.):_
___________________________________________________________________
[ ] 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.): _________________________________
[ ] Other accommodation (please specify): _____________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
7. Use the following “Submit” Button to send us your request:
Submit
Florida State Courts System Page 6 ADA Accommodation Request Form
THE FOLLOWING SECTION IS TO BE COMPLETED BY COURT PERSONNEL ONLY
8. Date request was received: ______/______/______
9. Additional oral or written information requested? [ ] Yes [ ] No
If so, describe information: ____________________________________________________
___________________________________________________________________________
10. Describe the accommodation(s) granted by the court: ______________________________
__________________________________________________________________________
11. Indicate the duration the accommodation will be provided: __________________________
___________________________________________________________________________
12. If an accommodation is denied, indicate reason(s) for denial:
3
[ ] Based on the information provided, it appears the person does not have a disability as
defined by the ADA
[ ] Requested accommodation does not directly correlate to functional limitations
[ ] Request relates to a service, program, or activity outside the court system
(transportation, legal representation, mental health counseling, parenting course, etc.)
[ ] Request is for an aid/service the courts cannot administratively grant as an
accommodation pursuant to Title II of the ADA (official transcript, extension of time, etc.)
[ ] Requested accommodation would result in an undue burden
[ ] Requested accommodation would result in a fundamental alteration
[ ] Other (please specify): _____________________________________________________
13. Remarks: __________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
14. Court staff responding to request: ______________________________________________
15. Date person notified of determination: ______/______/______
3
If the request is denied, granted only in part, or if an alternative accommodation is granted,
Rule of Judicial Administration 2.540 requires the court to respond in writing to the individual
with a disability. Transmittal of a copy of this section of the accommodation request form by
email or by U.S. Mail delivery is one means of providing the written response required by rule
2.540. If an accommodation is denied due to a finding of undue burden or fundamental
alteration, the Americans with Disabilities Act requires that such determination be made in
writing by the chief judge or chief judge’s designee.
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ADA Model Request Form (Florida)

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Completed 15 July 2020

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