The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02

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Here is the text we could read:

CONFIDENTIAL

Clerk receives and date stamps here.

Court Name and Address:

If you have a disability and need an accommodation while
you are at court, you can use this form to make your
request. For more information, see form .

Make this request at least 5 days (when the court
is open) before you need the accommodation.

1 Your information

MC-410 Disability Accommodation

Request

Name:

Address:

Phone:

Email:

Juror
Party
Other (explain):

location]

2 How are you involved in the case?

Witness

Lawyer

Case Name/Type (if you know it):

Case Number (if you know it):

3 When and where do you need the accommodation? [date(s), time(s), and court

4 What accommodation do you need at the court?

5 Why do you need this accommodation to assist you in court?

More information on this request is attached.

Date:

Type or print name

Signature

(Optional) If a court employee, caregiver or other person helped fill out this form and is
willing to provide more information if needed, provide contact information below:
Name:
Email:

Phone:

Judicial Council of California,
Rev. January 1, 2021, Optional Form
Cal. Rules of Court, rule 1.100

Disability Accommodation Request

MC-410, Page 1 of 2

Case Number (if you know it):

Name:

Court fills out below

Important! If your case is delayed or dismissed after you make this
request and you do not need the accommodation for the date you
specified under 3, please contact the court at:

(Optional)

Phone:

Email:

Your request is GRANTED. The court will provide the accommodation(s) requested.

Your request is DENIED IN WHOLE OR IN PART. The denied portion of your
request:

Does not meet the requirements of .

Creates an undue financial or administrative burden for the court.

Changes the basic nature of the court's service, program, or activity.

Explain the reasons supporting the box(es) checked above:

Instead, the court will provide the following accommodation(s):

The court will provide the accommodation(s):

For the date(s) and time(s) requested
On date(s):

Indefinitely

More information on this decision is attached.

Date:

Type or print name

Signature

The court responded in person, by phone, or mail/email on:

Note: You may be able to ask for a review of this decision.

explains how to do this.

Rev. January 1, 2021

Disability Accommodation Request

MC-410, Page 2 of 2

Disability Accommodation Request

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the California state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from selfhelp.courts.ca.gov (2023-03)
Page(s): 2
Fields(s): 43
Average fields per page: 21
Reading Level: Grade 7
LIST Grouping(s): CO-00-00-00-00, CO-07-00-00-00.

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

c_page_caption_p_right_text was MC-410[0].Page1[0].CaptionP1Right_sf[0].TextField6[0] (0.60 conf)
c_page_p_right_case_number__1 was MC-410[0].Page1[0].CaptionP1Right_sf[0].CaseNumber_ft[0] (0.39 conf)
c_page_p_right_case_number__2 was MC-410[0].Page1[0].CaptionP1Right_sf[0].CaseNumber_ft1[0] (0.39 conf)
c_page_list_l_name_info was MC-410[0].Page1[0].List1[0].LI1[0].NameInfo[0] (0.33 conf)
c_page_list_l_address__1 was MC-410[0].Page1[0].List1[0].LI1[0].Address[0] (0.33 conf)
c_page_list_l_address__2 was MC-410[0].Page1[0].List1[0].LI1[0].Address1[0] (0.33 conf)
c_page_list_l_phone was MC-410[0].Page1[0].List1[0].LI1[0].Phone[0] (0.33 conf)
c_page_list_l_email was MC-410[0].Page1[0].List1[0].LI1[0].Email[0] (0.33 conf)
c_page_list_l_check_juror was MC-410[0].Page1[0].List2[0].LI1[0].CheckJuror[0] (0.34 conf)
c_page_list_l_check_party was MC-410[0].Page1[0].List2[0].LI1[0].CheckParty[0] (0.34 conf)
c_page_list_l_check_witness was MC-410[0].Page1[0].List2[0].LI1[0].CheckWitness[0] (0.34 conf)
c_page_list_l_check_lawyer was MC-410[0].Page1[0].List2[0].LI1[0].CheckLawyer[0] (0.34 conf)
c_page_list_l_check was MC-410[0].Page1[0].List2[0].LI1[0].CheckOther[0] (0.34 conf)
c_page_list_l_name was MC-410[0].Page1[0].List2[0].LI1[0].Name[0] (0.33 conf)
c_page_list_l_text_field__1 was MC-410[0].Page1[0].List3[0].LI1[0].TextField4[0] (0.36 conf)
page_list_l_medical_condition was MC-410[0].Page1[0].List4[0].LI1[0].Medical-Condition[0] (0.38 conf)
c_page_list_l_text_field__2 was MC-410[0].Page1[0].List5[0].LI1[0].TextField4[0] (0.36 conf)
c_page_list_l_check_box was MC-410[0].Page1[0].List5[0].LI1[0].CheckBox3[0] (0.34 conf)
c_page_sign_date_time_field__1 was MC-410[0].Page1[0].SignSub[0].DateTimeField1[0] (0.35 conf)
c_page_sign_sub_name_info was MC-410[0].Page1[0].SignSub[0].NameInfo[0] (0.39 conf)
c_page_sign_sub_email was MC-410[0].Page1[0].SignSub[0].Email[0] (0.37 conf)
c_page_sign_sub_name was MC-410[0].Page1[0].SignSub[0].Name[0] (0.37 conf)
c_page_sign_sub_phone was MC-410[0].Page1[0].SignSub[0].Phone[0] (0.37 conf)
c_page_header_sub_name_info was MC-410[0].Page2[0].HeaderSub[0].NameInfo[0] (0.39 conf)
c_page_sub_case_number_ft was MC-410[0].Page2[0].HeaderSub[0].CaseNumber_ft[0] (0.43 conf)
c_page_instruction_text_field__1 was MC-410[0].Page2[0].InstructionSub[0].TextField1[0] (0.40 conf)
c_page_instruction_text_field__2 was MC-410[0].Page2[0].InstructionSub[0].TextField2[0] (0.40 conf)
c_page_subform_field_name_cb__1 was MC-410[0].Page2[0].Subform1[0].FieldName_cb[0] (0.39 conf)
c_page_subform_field_name_cb__2 was MC-410[0].Page2[0].Subform1[0].FieldName_cb1[0] (0.39 conf)
c_page_subform_check_box__1 was MC-410[0].Page2[0].Subform1[0].CheckBox1[0] (0.37 conf)
c_page_subform_check_box__2 was MC-410[0].Page2[0].Subform1[0].CheckBox2[0] (0.37 conf)
c_page_subform_check_box__3 was MC-410[0].Page2[0].Subform1[0].CheckBox3[0] (0.37 conf)
c_page_subform_text_field__1 was MC-410[0].Page2[0].Subform1[0].TextField4[0] (0.39 conf)
c_page_subform_check_box__4 was MC-410[0].Page2[0].Subform1[0].CheckBox4[0] (0.37 conf)
c_page_subform_text_field__2 was MC-410[0].Page2[0].Subform1[0].TextField5[0] (0.39 conf)
c_page_sign_sub_check_b__1 was MC-410[0].Page2[0].SignSub[0].CheckB1[0] (0.37 conf)
c_page_sign_sub_check_b__2 was MC-410[0].Page2[0].SignSub[0].CheckB1[1] (0.37 conf)
c_page_sign_sub_check_b__3 was MC-410[0].Page2[0].SignSub[0].CheckB1[2] (0.37 conf)
c_page_sign_sub_text_field was MC-410[0].Page2[0].SignSub[0].TextField2[0] (0.43 conf)
c_page_sign_sub_check_box was MC-410[0].Page2[0].SignSub[0].CheckBox4[0] (0.37 conf)
c_page_sign_date_time_field__2 was MC-410[0].Page2[0].SignSub[0].DateTimeField1[0] (0.35 conf)
c_page_sign_sub_name_ft was MC-410[0].Page2[0].SignSub[0].YourName_ft[0] (0.37 conf)
c_page_sign_sub_date_field was MC-410[0].Page2[0].SignSub[0].DateField1[0] (0.37 conf)

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Disability Accommodation Request

About This Form:

Identified Data Fields:

Create an Interactive Version of this Form:

The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02