Email Request Form

If you need an accommodation for a disability when participating in a court program, service, or activity, please contact one of the Disability Accommodations Coordinators as far in advance as possible to allow time to provide an accommodation.

Call Hilo (808) 961-7629, Honolulu (808) 538-5121, Kauai (808) 482-2347, Kona (808) 961-7629, or Maui (808) 244-2855; send an e-mail to adarequest@courts.hawaii.gov; or complete the form below. The Disability Accommodations Coordinator will try to provide, but cannot guarantee, the requested auxiliary aid, service, or accommodation.

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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