Accommodations for Persons with Disabilities
The Department of Administrative Hearings is dedicated to ensuring that all qualified
individuals with disabilities have equal access to our hearing process and other services
provided by the Department. Accommodations are made at no cost to you. Requests for
accommodations can be made orally or in writing. This form has been developed to
facilitate your request. Requests can be made at any time, but please give us as much time
as possible to make arrangements. There are several options. You can:
• Complete this form and return it to the Department of Administrative Hearings,
740 N. Sedgwick St., 6
th
Floor, Chicago, IL 60654, Attn: ADA Request;
• Email AdministrativeHearings@cityofchicago.org;
Please write on subject line of email “ADA Request”
• Contact us by telephone at 312-742-8200 or 312-742-4747 or;
• Fax to 312-742-8222 or Text Net (TTY) 312-742-8249.
Date request submitted: ____/____/____
Contact information for person needing accommodation (“Requester”)
(Check one) Respondent ____ Witness____ Attorney _____ Other (please specify)___________
Name: ________________________________________________________________________
Street or P.O Box: _______________________________________________________________
City: _________________________________ State: _____________________Zip:____________
Telephone Number (include area code): _____________________________________________
Email Address: __________________________________________________________________
IT IS IMPORTANT THAT YOU PROVIDE A CURRENT TELEPHONE NUMBER AND/OR EMAIL
ADDRESS SO WE MAY CONTACT YOU IF FURTHER INFORMATION IS NEEDED TO CLARIFY
YOUR REQUEST, TO NOTIFY YOU OF THE STATUS OF YOUR REQUEST, OR TO ADVISE YOU
OF A LATE CANCELLATION. (For example, the sign language interpreter is sick and cannot
cover the scheduled hearing.)
Case Information: Docket # ___________________________ Ticket # __________________________
Date that the accommodation is needed: ____/___/_____ Time accommodation needed:
_________
Location (check one):
Describe the accommodation that you are requesting:_________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
