Judiciary, State of Hawaii

If you need accommodation for a disability covered under state or federal disability law, please fill out the form below and click the link to contact one of the Disability Accommodations Coordinators.

ADA Accommodations Request Form

The Hawai`i State Judiciary is committed to providing equal access consistent with the Americans with Disabilities Act (ADA), the Americans with Disabilities Amendments Act of 2008 (ADAAA) and other state and federal laws. If you have a disability that may restrict your ability to meaningfully participate in court proceedings, programs, activities, or services we will provide you with reasonable and appropriate accommodations at no cost to you.

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Date (mm/dd/yyyy)

First Name*

Last Name*

Middle Initial

Home Address*

Street Address Apt. City State ZIP Code

Phone

Email Address

Court or program including circuit, address, location, time of your proceeding?*

Case Docket Number:

What is the nature of your disability?

What specific accommodation are you requesting?

Provide any additional information that might be useful in reviewing your accommodation request.

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Name

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