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.”
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______________________________________________________________
(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: (________) _________ - ______________
_____________________________________________________________________________________
_____________________________________________________________________________________
_________________________________
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:
Pinal County Superior Court
Court Administrator, P.O. Box 1748, Florence, AZ 85132
