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:

Grievance from Denial of Accommodation 

The Pennsylvania 
Judicial Center 

INSTRUCTIONS: If you filed a Request for Accommodation and feel your 
reasonable request was denied in whole or in part, or if the accommodation 
granted did not meet your needs, you may complete the following form and submit 
to the appropriate ADA Grievance Officer, as listed on the Appellate Court's web 
site. 

Name: 

Phone: ( 

) 

- 

Contact Information 

E-Mail: 

Address: 

Best way to contact you: 

Date you submitted your “Request for Accommodation”:  ______________________________ 

Court Information 

Date your request was denied: 

Appeal 

In  as  much  detail  as  possible  please  describe  your  original  request,  what  the  result  of  your 

request  for  accommodation  was,  and  the  reason  you  contend  your  original  request  was 

reasonable and why you should have been provided accommodations: 

Grievance Continued 

 

   

 

 

Signature of Requestor or Person completing request:   

Relationship to Requestor & contact information (if applicable):   

Date:   

 

*  You may add additional pages as necessary 

** Please attach any documents or exhibits that support your grievance. 

Note: You may have civil remedies under both State and Federal law.  Often these 

remedies have filing deadlines.  Filing this form with an ADA Grievance Officer will not 

preserve your filing date or extend the time for seeking relief elsewhere.

ADA Grievance Form (All Appellate Courts)

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Pennsylvania 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 www.pacourts.us (2023-03)
Page(s): 2
Fields(s): 43
Average fields per page: 21
Reading Level: Grade 11
LIST Grouping(s): Unknown

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.

af_f was AFF000 (0.65 conf)
page_field__1 was page_0_field_1 (0.31 conf)
page_field__2 was page_0_field_2 (0.31 conf)
users1_name was name (1.00 conf)
e_mail was e_mail (0.45 conf)
users1_address_line_one was address (1.00 conf)
page_field__3 was page_0_field_6 (0.31 conf)
best_way_contact was best_way_to_contact_you (0.41 conf)
page_field__4 was page_0_field_8 (0.31 conf)
page_field__5 was page_0_field_9 (0.31 conf)
court_information was court_information (0.41 conf)
date_request_denied was date_your_request_was_denied (0.42 conf)
reasonable_provided was reasonable_and_why_you_should_have_been_provided_accommodations (0.39 conf)
page_field__6 was page_0_field_13 (0.31 conf)
page_field__7 was page_0_field_14 (0.31 conf)
page_field__8 was page_0_field_15 (0.31 conf)
grievance_denial_accommodation was grievance_from_denial_of_accommodation (0.31 conf)
appropriate_officer_court was to_the_appropriate_ada_grievance_officer__as_listed_on_the_appellate_court_s_web (0.41 conf)
page_check was page_0_check_2 (0.33 conf)
page_field__9 was page_1_field_0 (0.31 conf)
page_field__10 was page_1_field_1 (0.36 conf)
page_field__11 was page_1_field_2 (0.36 conf)
page_field__12 was page_1_field_3 (0.36 conf)
page_field__13 was page_1_field_4 (0.36 conf)
page_field__14 was page_1_field_5 (0.36 conf)
page_field__15 was page_1_field_6 (0.36 conf)
page_field__16 was page_1_field_7 (0.36 conf)
page_field__17 was page_1_field_8 (0.36 conf)
page_field__18 was page_1_field_9 (0.36 conf)
page_field__19 was page_1_field_10 (0.36 conf)
page_field__20 was page_1_field_11 (0.36 conf)
page_field__21 was page_1_field_12 (0.36 conf)
page_field__22 was page_1_field_13 (0.36 conf)
page_field__23 was page_1_field_14 (0.36 conf)
page_field__24 was page_1_field_15 (0.36 conf)
page_field__25 was page_1_field_16 (0.36 conf)
page_field__26 was page_1_field_17 (0.36 conf)
contact_applicable was relationship_to_requestor_contact_information__if_applicable (0.40 conf)
page_field__27 was page_1_field_19 (0.36 conf)
page_field__28 was page_1_field_20 (0.36 conf)
signature_date was date (1.00 conf)
please_attach_exhibits was please_attach_any_documents_or_exhibits_that_support_your_grievance (0.44 conf)
extend_time_elsewhere was preserve_your_filing_date_or_extend_the_time_for_seeking_relief_elsewhere (0.43 conf)

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

ADA Grievance Form (All Appellate Courts)

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