18TH JUDICIAL DISTRICT 
 
AMERICANS WITH DISABILITIES ACT (TITLE II) POLICY 

he Unified Judicial System of Pennsylvania (UJS) complies with Title II of the 
Americans with Disabilities Act (ADA) which provides that “no qualified individual 
with a disability shall, by reason of such disability, be excluded from participation 
in or be denied the benefits of the services, programs, or activities of a public 
entity, or be subjected to discrimination by any such entity”.  42 U.S.C.A. §12132.  
Pursuant to that requirement, if you are an individual with a disability who needs 
an accommodation in order to participate in any judicial proceeding or any other 
service, program, or activity of the UJS, you are entitled, at no cost to you, to the 
provision of certain assistance.  The ADA does not require the 18th Judicial 
District  to take any action that would fundamentally alter the nature of its 
programs or services, or impose an undue financial or administrative burden. 
  
If you require an accommodation under the ADA, it is recommended that you 
make your request as soon as possible or at least three (3) business days before 
your scheduled participation in any court proceeding or activity.  All requests for 
accommodation, regardless of timeliness, will be given due consideration and if 
necessary, may require an interactive process between the requestor and the 
18th Judicial District to determine the best course of action.  
  
To request a reasonable accommodation, please complete the Request for 
Reasonable Accommodation Form (Appendix A) and return it to: 
 

Tami M. Kline, Assistant Court Administrator 
ADA Coordinator 
Clarion County Courthouse 
421 Main Street, Suite 34 
Clarion, PA 16214 
Phone:  (814)226-4000 ext. 2102 
Fax:   (814)226-1097 
Email:  tkline@co.clarion.pa.us 
 

f you need assistance completing this form, contact the ADA Coordinator.   
Complaints alleging violations of Title II under the ADA may be filed pursuant to 
the UJS Grievance Procedure with the ADA Coordinator listed above.  A 
response will be sent to you after careful review of the facts. 

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APPENDIX A 
FOR USE BY JUDICIAL DISTRICTS ONLY 
 
UNIFIED JUDICIAL SYSTEM OF PENNSYLVANIA 

 

AMERICANS WITH DISABILITES ACT ACCOMMODATION (ADA) TITLE II  REQUEST FOR REASONABLE ACCOMMODATION FORM 
(INCLUDES REQUEST FOR INTERPRETER FOR HEARING /SPEECH IMPAIRED) 

 Litigant        

 Plaintiff       

 Parent       

 Child       

 Witness       

 Attorney        

 Victim       

  Juror  

Client Information – Section A 

Name:             

Address:             

 
 
Please check the box that most closely describes your status in this matter: 

           
 

 Other (please explain) 

 Defendant       
           

 

Requestor Information   (if different from above) 

Name:

           

Address:             

           

Relationship 

to Client:             

 

Phone: 

           

Email: 

           

Mobile: 

           
 

 

Bus. Phone/ 
Mobile: 

           

Fax: 

           

Email: 

           

TTY: 

           

 

Accommodation 
Nature of the disability for which an accommodation is requested: 
           

           

Accommodation requested: 

           

 

Location of Proceeding 

  Magisterial District Court No.  

           

District Judge Name: 

           

 

  Criminal Division   

 Civil Division    

 Orphans’ Court Division 

   Family Division      

 Adult       

 Juvenile 

Specify Address:             

AFTER COMPLETING THE FORM, PLEASE SEND TO: COURT ADA COORDINATOR 

Proceeding Information (if known) 

Case #: 

           

Case Name: 

           

Judge: 
Proceeding 
Date: 
Proceeding 
Type: 

           

           

           

 

 

Proceeding 
Time: 

           

 hereby certify that an Americans with Disabilities Act accommodation is required in the above-captioned action on the date stated. 

Signature: 

           

Date: 

           

 

 

Court Official Verification – Section C 
VERIFYING OFFICIAL SHALL MAINTAIN A COPY IN THE COURT’S CASE FILE AND PROVIDE THE ORIGINAL TO THE SERVICE PROVIDER FOR SUBMISSION WITH BILLING.    

 hereby verify that the services were performed by the provider in the above-captioned action on the date and time stated. 

Fax: 

           

Email: 
Date to 
Provider: 

           

           

 

End Date 
& Time: 

Signature: 

           

           
           
 

Date: 

 

FOR OFFICIAL USE ONLY 
Service Provider Information - Section B 
A SERVICE REQUEST HAS BEEN MADE FOR THE CLIENT NAMED ABOVE.     
Service Provider 
Company:  
Individual 
Interpreter Name: 
Bus. Phone/ 
Mobile: 

           

           

           

   

Start Date 
& Time: 

           

Court Official: 

           
(Please print name) 

Title: 

           

 

     

   

 

 

 

 

 

 

 

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