Disability Accommodation Request

Cal. Form MC-410

California Superior Local Rules

Judicial Council of California, Rev. January 1, 2021, Optional Form Cal. Rules of Court, rule 1.100 Disability Accommodation Request MC-410, MC-410 Disability Accommodation Request CONFIDENTIAL Clerk receives and date stamps here. Court Name and Address: Case Number (if you know it): Case Name/Type (if you know it): 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 Name: Address: Phone: Email: 2 How are you involved in the case? Juror Party Witness Lawyer Other (explain): 3 When and where do you need the accommodation? [date(s), time(s), and court location] 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: Email:Name: Phone: Rev. January 1, 2021 Disability Accommodation Request MC-410, Name: Case Number (if you know it): 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 Indefinitely On date(s): 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.

Document details

Collection	California Superior Local Rules
Citation	Cal. Form MC-410
Type	court_rule
Language	en
Format	pdf
Source	CA_LOCAL
Identifier	7433aa0914706b5ba463c0ab91f43ec586c791ff

Source file is stored in the law ingest library (pdf).