Maryland > Statewide > District Court > Accounting
Request For Accommodation DCA 92 - Maryland
| Request For Accommodation Form. This is a Maryland form and can be used in Accounting District Court Statewide . |
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REQUESTFOR ACCOMMODATIONS Use thisform to requestaccommodationsor to filea complaintif yourrequestfor accommodationshas not beensatisfied.CourtLocation:.........................................................................................................................................................Name: ................................................................................................TelephoneNumber: .....................................Address: ....................................................................................................................................................................City/State:.................................................................................................................ZipCode: .............................Dateof Requestfor Accommodation/Complaint:.................................................................................................... ACCOMMODATIONREQUESTED COMPLAINT Pleaseprintor type and be as specificas possible.(Useothersideifnecessary.) Signature:..........................................................................................Date: .............................................................Have you filed a complaintwith a Federal,Stateor LocalAgency? Yes No If yes,indicateagency: .................................................................................................................................Pleasereturnto the localcoordinatoror DistrictCourt of MarylandHeadquarters,TawesBuildingA-3 - HumanResources,580 TaylorAvenue,Annapolis,Md. 21401.You will receivean initialresponsewithin10 workingdays upon receiptof this documentin our office.If you have any questionspleasecallthe District CourtHumanResourcesOffice(410)260-1200. Signatureof ADA Coordinator:........................................................Date:.............................................................. Copy forwardedto DistrictCourtHeadquarters DCA 92 (Rev.2/99)
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