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Request For Accommodations - Michigan

Request For Accommodations Form. This is a Michigan form and can be used in General Oakland Local County .
 Fillable pdf Last Modified 2/11/2005
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Sixth Judicial Circuit Court REQUEST FOR ACCOMMODATIONS Attn: Court Administrator's Office 1200 North Telegraph Road Pontiac, MI 48341-04404 (248) 858-0345 Today's date Instructions for completing form: Provide your name, address, and telephone number. Check the boxes that apply to you and provide any necessary details. When you have completed this request, please return it to the court at the above address. 1. Name Address City 2. State Zip Telephone no. Court activity you need accommodations for: Hearing Mediation meeting Date Date Jury duty Date(s) Other (specify): 3. What is the nature of your disability? include dates if relevant Physical mobility impairment (wheelchair, walker, crutchers, etc.) Speech impairment (specify): Visual impairment Hearing impairment (specify) Other (specify): 4. Please indicate the nature of your involvement in this case: Party Witness Juror 5. Lawyer Parent Family member Guardian Other (specify): deaf hard of hearing What type of accommodations are you requesting? Interpreter for deaf (specify whether ASL, tactile, oral, etc.) Assistive listening device (specify type of device) Physical location accessible for persons with a physical mobility concern. Other (specify): 6. Please estimate the number of days you will need this accommodation. (1/99) REQUEST FOR ACCOMMODATIONS 2001 © American LegalNet, Inc.
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