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:

Request for Accommodation 

The Pennsylvania 
Judicial Center 

INSTRUCTIONS: If you have a disability and need access to the Unified 
Judicial System of Pennsylvania, please complete the following form 
and submit to the appropriate ADA Coordinator listed on the web page 
as soon as possible,  but no later than three business days before you need 
an accommodation. 

Name: 

Phone: ( 

) 

- 

Contact Information 

E-Mail: 

Address: 

Best way to contact you: 

Court: 

Office/Location: 

Case Docket Number: 

To aid in accommodating you, please provide as much information as you can below. 

Court Information 

Relation to Case: 

Attorney/Legal Staff 

Party 

Other: 

Date and Time Accommodation Needed: 

at 

AM 

PM 

A 

Request for Accommodation 
(continued from Page 1) 

Accommodation Information 

Access Accommodation:  If you are requesting an accommodation to physically access a 

Courtroom or Filing Office, please describe what accommodations you are requesting below. 

(Add additional pages if you need to) 

Access Accommodation Requested: 

Issue-Related Accommodation:  If you are requesting any accommodations to interact with 

the Court, please select from the accommodation(s) below.  If you do not see accommodations 

listed that would fit your needs, please describe alternatives in the “Other” section: 

Large Print 

Digital Audio Reading 

CART (Computer Access Real-Time Translation) 

Sign Language Interpreter 

Assistive Listening Device 

Other: 

Please briefly describe the nature of your disability: 

Signature of Requestor or Person completing form: 

Relationship to Requestor & contact information (if applicable): 

Date:

ADA Request Accommodation 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): 39
Average fields per page: 19
Reading Level: Grade 12
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)
aid_please_much was to_aid_in_accommodating_you__please_provide_as_much_information_as_you_can_below (0.39 conf)
office_location was office_location (0.42 conf)
attorney_legal_staff was attorney_legal_staff (0.46 conf)
other was other (0.43 conf)
at was at (0.35 conf)
date_accommodation_needed was date_and_time_accommodation_needed (0.34 conf)
page_check__1 was page_0_check_0 (0.34 conf)
party was party (0.32 conf)
page_check__2 was page_0_check_2 (0.33 conf)
am was am (0.45 conf)
pm was pm (0.35 conf)
access_accommodation_requested was access_accommodation_requested (0.41 conf)
page_field__5 was page_1_field_1 (0.36 conf)
page_field__6 was page_1_field_2 (0.36 conf)
accommodation_accommodations was issue_related_accommodation_if_you_are_requesting_any_accommodations_to_interact_with (0.39 conf)
page_field__7 was page_1_field_4 (0.36 conf)
page_field__8 was page_1_field_5 (0.36 conf)
please_describe_nature was please_briefly_describe_the_nature_of_your_disability (0.48 conf)
page_field__9 was page_1_field_7 (0.36 conf)
page_field__10 was page_1_field_8 (0.36 conf)
contact_applicable was relationship_to_requestor_contact_information__if_applicable (0.40 conf)
page_field__11 was page_1_field_10 (0.36 conf)
page_field__12 was page_1_field_11 (0.36 conf)
signature_date was date (1.00 conf)
large_print was large_print (0.34 conf)
digital_audio_reading was digital_audio_reading (0.40 conf)
sign_language_interpreter was sign_language_interpreter (0.32 conf)
page_check__3 was page_1_check_3 (0.26 conf)
assistive_listening_device was assistive_listening_device (0.39 conf)
page_check__4 was page_1_check_5 (0.26 conf)

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

ADA Request Accommodation 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