NAVAJO COUNTY SUPERIOR COURT

COURT ACCESS INFORMATION FOR PERSONS WITH DISABILITIES

Applicant Name:

 

 

Applicant is:  Witness     Juror          Attorney   Party         Other (specify)

 

 

Applicant’s Mailing Address:

 

 

 

Applicant’s Telephone Number:

  Home       Mobile

 

Applicant’s Email Address:

 

 

Name of Court or Court Program, Service or Activity for which accommodation is requested:

 

 

Address/Location of Court/Program/Service/Activity:

 

 

If Accommodation is for Court Case, Specify -

 

Case Name:

 

Case Number:

 

If you need assistance completing the Request for Accommodations form, please contact the ADA Coordinator for assistance. Alternative means of submitting an accommodation request, such as by personal interview or tape recording, will be made available to qualified individuals with disabilities upon request.

 

Upon receiving the form, the ADA Coordinator will, as soon as reasonably possible, provide a Response to the Request for Accommodation.

ADA Coordinator
Navajo County Superior Court
P.O. Box 668

100 E. Code Talkers Drive

Holbrook, Arizona 86025
Phone: 928-524-4223
E-mail:
NCCourtadmin@courts.az.gov

Fax: 928-524-4325


 

 

REQUEST FOR ACCOMMODATIONS BY PERSONS WITH DISABILITIES AND RESPONSE

 

REQUEST FOR ACCOMODATIONS

Applicant requests accommodation under Title II of the Americans with Disabilities Act, as follows:

1.      Type of proceeding or court service, activity or program:      Criminal               Civil

Other(specify): _________________________________________________________________

2.      Proceedings to be covered (e.g., trial, bail hearing, preliminary hearing, particular witnesses at trial, sentencing hearing, or other court service, program or activity):

_______________________________________________________________________________

3.      Dates accommodations needed (specify):

_______________________________________________________________________________

4.      Impairment necessitating accommodations (specify):

­­­­­­­­­­­­­­_______________________________________________________________________________

5.      Type of accommodations (specify):

_______________________________________________________________________________

6.      Special requests or anticipated problems (specify):

_______________________________________________________________________________

 

Print Name:___________________________ Signature:_____________________________________

 

Please give the completed form and any relevant documents to the Navajo County Superior Court courtroom staff, the Clerk’s Office, Court Administration, or submit by mailing to the ADA Coordinator:

ADA Coordinator
Navajo County Superior Court
P.O. Box 668

100 E. Code Talkers Drive

Holbrook, Arizona 86025
Phone: 928-524-4223
E-mail:
NCCourtadmin@courts.az.gov

Fax: 928-524-4325


 

 

RESPONSE TO REQUEST FOR ACCOMMODATIONS

 

 

The request for accommodation is GRANTED:

The Applicant satisfies the requirements of the rule.

It does not create an undue burden on the court.

It does not fundamentally alter the nature of the service, program or activity.

Alternate Accommodations granted (specify):

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

The request for accommodation is DENIED:

The Applicant does not satisfy Title II’s requirements; and/or

It would create an undue burden on the court; and/or

It would fundamentally alter the nature of the service, program, or activity.

 

Additional Remarks:

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

 

 

Date:____________  ADA Coordinator / Designee Signature:____________________________________

 

 

 

Grievance Procedures: If you are dissatisfied with the response to your request, you may utilize the Grievance Procedures described in Navajo County Superior Court’s Notice of Court Access Information for Persons with Disabilities. Grievances must be filed within sixty (60) days of the alleged discriminatory act. You may also utilize any other remedy allowed under federal or state law by filing a complaint with the appropriate federal or state agency.