Minnesota > Local County > Dakota > District Court > ADA

Request For Reasonable Accomodation - Minnesota

Request For Reasonable Accomodation Form. This is a Minnesota form and can be used in ADA District Court Dakota Local County .
 Fillable pdf Last Modified 2/20/2014
Get this form for FREE as a print-only pdf

REQUEST FOR REASONABLE ACCOMMODATION In compliance with Title II (Program Accessibility Requirements) of the Americans with Disabilities Act (ADA) Name: _____________________________________________ Address: ___________________________________ City/State: _______________ Zip: ______________ Home Phone: ____________________ Work Phone: _________________ Cell Phone: _______________ Check here if requesting on behalf of another Name: _____________________________________________ Address: ___________________________________ City/State: _______________ Zip: ______________ Home Phone: ____________________ Work Phone: _________________ Cell Phone: _______________ Description of accommodation requested. (Please be as specific as possible. Attach additional sheets if necessary.) Date Needed: County: ___________________ ___________________ Court File Number: __________________ Location: __________________ Suggested course of action by the court which the requester believes would best resolve the situation. Please provide as much information as possible: Requester Signature: _______________________________ Date: ________________________ Upon completion please submit form to the appropriate county Court Administrator (addresses listed below): Carver ­ Vicky Carlson McLeod ­ Karen Messner Dakota ­ Carol Renn Scott ­ Greg Ess Goodhue ­ Yvonne Black Sibley ­ Karen Messner Le Sueur ­ Joanne Kopet COURT USE ONLY Request Received: Action Taken: Final Outcome: ___ Accepted Request ___ Unable to Accept Request Reason: ___ Accepted Request with Modification Signature: ____________________________ Date: ____________________ American LegalNet, Inc. www.FormsWorkFlow.com County Courthouse Address Directory Carver County Court Administration Carver County Justice Center 604 E 4th St Chaska, MN 55318 Phone: 952-361-1420 Fax: 952-361-1491 Dakota County Court Administration Dakota County Judicial Center 1560 W Hwy 55 Hastings, MN 55033 Phone: 651-438-8100 Fax: 651-438-8160 Goodhue County Court Administration Goodhue County Justice Center 454 W 6th St Red Wing, MN 55066 Phone: 651-267-4800 Fax: 651-267-4989 McLeod County Court Administration McLeod County Courthouse 830 11th St E Glencoe, MN 55336 Phone: 320-864-5551 Fax: 320-864-5905 Scott County Court Administration Scott County Justice Center 200 Fourth Ave W Shakopee, MN 55379-1220 Phone: 952-496-8200 Fax: 952-496-8211 Sibley County Court Administration Sibley County Courthouse PO Box 867 400 Court Ave Gaylord, MN 55334 Phone: 507-237-4051 Fax: 507-237-4062 Le Sueur County Court Administration Le Sueur County Courthouse 88 S Park Ave Le Center, MN 5605 Phone: 507-357-8252 Fax: 507-357-6433 American LegalNet, Inc. www.FormsWorkFlow.com
Link/Embed this Document
URL
Embed


Popular Searches

  1. statement of claim
  2. settlement
  3. claim of exemption
  4. garnishment
  5. Unlawful Detainer
  6. contempt
  7. small claims
  8. adoption
  9. appearance
  10. small estate affidavit

Bookmark and Share