Michigan > Statewide > General
Request For Accommodations MC 70 - Michigan
| Request For Accommodations Form. This is a Michigan form and can be used in General Statewide . |
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Approved, SCAO Court name and location REQUEST FOR ACCOMMODATIONS Today's date Instructions for completing form. Provide your name, address, and telephone number. Check the boxes which 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 State Zip Telephone no. 2. Court activity you need accommodations for: Hearing Date Mediation meeting Date Jury duty Date(s) Other (specify): include dates if relevant 3. What is the nature of your disability? Physical mobility impairment (wheelchair, walker, crutches, etc.) Speech impairment (specify): Visual impairment Hearing impairment (specify): Other (specify): 4. What type of accommodation are you requesting? Interpreter for deaf (specify whether ASL, tactile, oral, etc.): headphones neckloop computer-assisted real-time captioning (CART) other: NOTE: To determine if other accommodations are available, contact the Division on Deaf and Hard of Hearing, 201 N. Washington Square, Suite 150, Lansing, MI 48913, telephone 517-335-6004, T/V toll free 877-499-6232, T/V fax 517-335-7773. Physical location accessible for persons with a physical mobility concern. Other (specify): 5. If the request for accommodation is denied or if the accommodation does not successfully establish effective communication, deaf hard of hearing deaf-blind Assistive listening device (specify): the applicant may file a grievance in accordance with the court's established grievance procedure. Upon request, the court shall provide the applicant a copy of the court's established grievance procedure. For court use only MC 70 (3/11) REQUEST FOR ACCOMMODATIONS MCL 393.501 et seq., 42 USC 12111 et seq. American LegalNet, Inc. www.FormsWorkFlow.com
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