Form CN:11507 "Americans With Disabilities Act (Ada) Accommodation Appeal Form for Court Users" - New Jersey

Form CN:11507 Printable Pdf
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What Is Form CN:11507?

This is a legal form that was released by the New Jersey Judiciary Court System - a government authority operating within New Jersey. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 15, 2011;
  • The latest edition provided by the New Jersey Judiciary Court System;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CN:11507 by clicking the link below or browse more documents and templates provided by the New Jersey Judiciary Court System.

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Download Form CN:11507 "Americans With Disabilities Act (Ada) Accommodation Appeal Form for Court Users" - New Jersey

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New Jersey Judiciary
Americans with Disabilities Act
Accommodation Appeal Form
for Court Users
Contact Information
Last Name
First Name
Middle Name
Address
City
State
Zip Code
Telephone Number(s)
Date
Home Number:
Daytime Number:
Alternate Contact
Last Name
First Name
Middle Name
Address
City
State
Zip Code
Telephone Number(s)
Home Number:
Daytime Number:
Appeal Information
Where were you seeking
Supreme
Appellate
Tax
Municipal
Court
Division
Court
Court
an accommodation:
Superior Court
Other
(County or Local Court)
Court / Division / Unit
Location (City / County)
Revised: 07/15/2011, CN: 11507
page 1 of 2
Print Form
Clear Form
New Jersey Judiciary
Americans with Disabilities Act
Accommodation Appeal Form
for Court Users
Contact Information
Last Name
First Name
Middle Name
Address
City
State
Zip Code
Telephone Number(s)
Date
Home Number:
Daytime Number:
Alternate Contact
Last Name
First Name
Middle Name
Address
City
State
Zip Code
Telephone Number(s)
Home Number:
Daytime Number:
Appeal Information
Where were you seeking
Supreme
Appellate
Tax
Municipal
Court
Division
Court
Court
an accommodation:
Superior Court
Other
(County or Local Court)
Court / Division / Unit
Location (City / County)
Revised: 07/15/2011, CN: 11507
page 1 of 2
Americans with Disabilities Act --Accommodation Appeal Form (Continued)
Description of Appeal
Please describe your request for an accommodation and why you believe you have
been denied an effective ADA accommodation to access and/or participate in any
court proceeding, judiciary program, service, or activity. Please provide date(s),
time(s) and place(s) of event(s), and include name(s) or title(s) of any judiciary
employees involved. Please also provide names, addresses, and telephone
numbers of any witnesses. Please attach additional pages if necessary and sign
and date those pages.
Signature:
Date:
If you need help completing this form, please contact the local Title II ADA
coordinator. Please return this completed form to the local Title II ADA
coordinator. Name and contact information for the local Title II ADA
coordinators can be found in the Judiciary Title II ADA procedures for access to
the courts by individuals with disabilities brochure or at njcourts.com.
The Judiciary will provide a reasonable accommodation for court users with a
disability, enabling them to access and participate in court proceedings, programs,
services and activities, provided that the accommodation does not fundamentally
alter the nature of a judiciary program, service, or activity or impose an undue
hardship upon the Judiciary.
NOTE: You have the right to pursue whatever remedies are available under state
law (New Jersey Division on Civil Rights) and federal law (U.S. Department of
Justice). You should be aware that there are time limits for filing claims with
outside agencies. Check with the outside agency for its filing deadlines.
t
Revised: 07/15/2011, CN: 11507
page 2 of 2
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