"Request for Modification" - Tennessee

Request for Modification is a legal document that was released by the Tennessee State Courts - a government authority operating within Tennessee.

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Download "Request for Modification" - Tennessee

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REQUEST FOR MODIFICATION
Applicant requests accommodation under Tennessee Judicial Branch Policy 2.07
Applicant Information
Applicant is: ____ Witness
_____ Juror
____ Attorney
_____ Party
_ _ _ _ _ O t h e r ( S p e c i f y
Nature of Interest):______
_____________________
Name:____________________________________
Court:____________________________________
Telephone:________________________________
__________________________________________
Address:__________________________________
Judge:____________________________________
__________________________________________
Case No.:__________________________________
1.
Type of proceeding.
_____ Criminal
_____ Civil
2.
Proceedings to be covered (e.g., bail hearing, preliminary hearing, particular witnesses at trial, sentencing
hearing, motion hearing, trial):___________________________________________________________
___________________________________________________________________________________________
3.
Dates modification needed (specify): ______________________________________________________
4.
Disability necessitating modification (specify):______________________________________________
___________________________________________________________________________________________
5.
Type of modification requested (specify):__________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
6.
Special requests or anticipated problems (specify):___________________________________________
___________________________________________________________________________________________
I hereby certify that the above information is true and correct to the best of my knowledge.
Date:
___________________________
_________________________________________________
(Signature of Applicant)
G The request for modification is GRANTED.
G OFFER OF REASONABLE ALTERNATE MODIFICATION __________________________________
___________________________________________________________________________________________
G The request for modification is DENIED because:
____ the applicant is not a qualified individual with a disability
____ the requested modification would fundamentally alter the nature of the judicial program, service or activity
____ the requested modification would create an undue financial or administrative burden
____ the applicant refused to comply with the Policy
____ the applicant’s failure to comply with the Policy makes impossible or impracticable the ability to provide the
requested Modification
(Specify)___________________________________________________________________________________
DATE: ____________________________
__________________________________________
Local Judicial Program ADA Coordinator
REQUEST FOR MODIFICATION
Applicant requests accommodation under Tennessee Judicial Branch Policy 2.07
Applicant Information
Applicant is: ____ Witness
_____ Juror
____ Attorney
_____ Party
_ _ _ _ _ O t h e r ( S p e c i f y
Nature of Interest):______
_____________________
Name:____________________________________
Court:____________________________________
Telephone:________________________________
__________________________________________
Address:__________________________________
Judge:____________________________________
__________________________________________
Case No.:__________________________________
1.
Type of proceeding.
_____ Criminal
_____ Civil
2.
Proceedings to be covered (e.g., bail hearing, preliminary hearing, particular witnesses at trial, sentencing
hearing, motion hearing, trial):___________________________________________________________
___________________________________________________________________________________________
3.
Dates modification needed (specify): ______________________________________________________
4.
Disability necessitating modification (specify):______________________________________________
___________________________________________________________________________________________
5.
Type of modification requested (specify):__________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
6.
Special requests or anticipated problems (specify):___________________________________________
___________________________________________________________________________________________
I hereby certify that the above information is true and correct to the best of my knowledge.
Date:
___________________________
_________________________________________________
(Signature of Applicant)
G The request for modification is GRANTED.
G OFFER OF REASONABLE ALTERNATE MODIFICATION __________________________________
___________________________________________________________________________________________
G The request for modification is DENIED because:
____ the applicant is not a qualified individual with a disability
____ the requested modification would fundamentally alter the nature of the judicial program, service or activity
____ the requested modification would create an undue financial or administrative burden
____ the applicant refused to comply with the Policy
____ the applicant’s failure to comply with the Policy makes impossible or impracticable the ability to provide the
requested Modification
(Specify)___________________________________________________________________________________
DATE: ____________________________
__________________________________________
Local Judicial Program ADA Coordinator
APPEALS
G
Presiding Judge Review requested. (Specify reason and the remedy you want): ______________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
DATE:____________________________
__________________________________________________
(Signature of Person Requesting Review)
PRESIDING JUDGE REVIEW
I have reviewed the original request for modification, the offer of alternate modification OR the denial of
modification and the reason for the denial, and the reason that this review has been requested and find as follows:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
DATE:____________________________
__________________________________________________
PRESIDING JUDGE
G
Administrative Office of the Courts Review requested. (Specify reason and the remedy you want):__________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
DATE:____________________________
___________________________________________________
(Signature of Person Requesting Review)
ADMINISTRATIVE OFFICE OF THE COURTS REVIEW
I have reviewed the original request for modification, the offer of alternate modification OR the denial of
modification and the reason for the denial, and the reason that this review has been requested and find as follows:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
DATE:__________________________
__________________________________________________
AOC DIRECTOR
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