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AMERICANS WITH DISABILITIES ACT (TITLE II) POLICY
OF THE 26TH JUDICIAL DISTRICT
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 26TH 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 five (5) business days before
your scheduled participation in any court proceeding or UJS program 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 26th 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:
DA Coordinator, Gina Theiss, Deputy Court Administrator, 35 West. Main St.
P O Box 380, Bloomsburg, PA 17815. Phone: 570-389-5679, fax 570-389-5621
or e-mail to: gtheiss@columbiapa.org
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 Tami B. Kline, District Court Administrator
at the same address, phone: 570-389-5692 or email tkline@columbiapa.org. 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 RESEASONABLE 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)
Accommodation
Nature of the disability for which an accommodation is requested:
Name:
Address:
Relationship
to Client:
Accommodation requested:
Location of Proceeding
Magisterial District Court No.
District Judge Name:
Phone:
Email:
Mobile:
Bus. Phone/
Mobile:
Fax:
Email:
TTY:
Proceeding Information (if known)
Criminal Division
Civil Division
Orphans’ Court Division
Family Division
Adult
Juvenile
Specify Address:
AFTER COMPLETING THE FORM, PLEASE SEND TO: COURT ADA COORDINATOR
GINA THEISS, ASSISTANT COURT ADMINISTRATOR, 35 W. MAIN ST., BLOOMSBURG, PA 17815
Proceeding
Time:
I 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.
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:
Case #:
Case Name:
Judge:
Proceeding
Date:
Proceeding
Type:
Fax:
Email:
Date to
Provider:
End Date
& Time:
Signature:
Date:
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Americans with Disabilities (Title II) Act Grievance Procedure
OF THE 26TH JUDICIAL DISTRICT
his grievance procedure is established for the prompt resolution of complaints
alleging any violation of Title II of the Americans with Disabilities Act (ADA) in the
provision of services, programs, or activities by the Unified Judicial System
(UJS). If you require a reasonable accommodation to complete this form, or
need this form in an alternate format, please contact ADA coordinator Gina
Theiss, 35 W. Main St., P O Box 380, Bloomsburg, PA 17815 or phone 570-
389-5679, fax no. 570-389-5621.
o file a complaint under the Grievance Procedure please take the following
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steps:
1. Complete the complaint form and return to Deputy Court Administrator,
Gina Theiss. Alternative means of filing complaints will be made
available for persons with disabilities upon request. The complaint
should be submitted as soon as possible but no later than sixty (60)
calendar days after the alleged violation.
2. Within fifteen (15) calendar days of receipt of the complaint, the ADA
Coordinator, Gina Theiss, will investigate the complaint, including,
meeting with the individual seeking an accommodation, either in person
or via telephone, to discuss the complaint and the possible resolutions.
Within fifteen (15) calendar days of the meeting, the ADA Coordinator
will respond in writing, and where appropriate, in a format accessible to
the complainant, such as large print, Braille, or audio. The response
will explain the position of the 26th Judicial District and offer options for
substantive resolution of the complaint.
. If the response to the complaint does not satisfactorily resolve the
issue, the complainant may appeal the decision within fifteen (15)
calendar days after receipt of the response to Tami B. Kline, District
Court Administrator. Within fifteen (15) calendar days after receipt of
the appeal, the District Court Administrator will meet with the
complainant to discuss the complaint and possible resolutions. Within
fifteen (15) calendar days after the meeting, the Court Administrator
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will respond in writing, and, where appropriate, in a format accessible to
the complainant, with a final resolution of the complaint.
This grievance procedure is informal. An individual’s participation in this informal
process is completely voluntary. Use of this grievance procedure is not a
prerequisite to and does not preclude a complainant from pursuing other
remedies available under law.
he UJS Policy on Non-Discrimination and Equal Employment Opportunity also
encompasses disability-related issues and provides complaint procedures for
UJS court users. Any employment-related disability discrimination complaints
will be governed by the UJS Policy on Nondiscrimination and Equal Employment
Opportunity.
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APPENDIX B
UNIFIED JUDICIAL SYSTEM OF PENNSYLVANIA
AMERICANS WITH DISABILITES ACT (ADA) TITLE II
GRIEVANCE FORM
Grievant Information
Alternative Contact Person (other than Grievant)
Home Phone
(include area code):
Business Phone
(include area code):
Mobile Phone
(include area code):
Home Phone
(include area code):
Business Phone
(include area code):
Relationship
To Client:
Court Service, Program or Facility Allegedly in Violation
Date and Location of Alleged Violation (dd/mm/yyyy)
Description of Alleged Violation and Requested Remedy
Has this case been filed with the Department of Justice or other government agency or court?
If You Answered “Yes” to the Previous Question, Complete the Following
Contact Person:
Phone
(include area code):
Date Filed:
Grievant Name:
Address:
Name:
Address:
Yes No
Agency or Court:
Address:
Other Comments
Signature: ________________________________________________ Date: __________________________________________
