Email Request Form

Please submit your completed form at least 10 business days prior to the date you need your accommodation. See the attached list for ADA coordinator contact information for each Court Circuit.

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.

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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Email
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