A.D.A. Accommodation Request Personal and Contact Information: Name of person needing accommodation: Address of person needing accommodation: Name of person filling out this form, if different than person needing accommodation: E-mail address for contact if additional information is required: Phone number for contact if additional information is required: Accommodation Request Details: Type of accommodation needed (What is your disability?): Location of Court Appearance: Date of Court Appearance: Court Appearance Time: Please leave this field empty.