INSTRUCTIONS: CONNECTICUT REQUEST FOR ACCOMMODATION BY PERSONS WITH DISABILITIES (Form JD-ES-264)

To request reasonable accommodation for a person with disabilities as defined by the Americans With Disabilities act at a Connecticut courthouse during the course of a trial, use form JD-ES-264. This form can be obtained from the website of the Connecticut Judicial Branch.

Connecticut Request For Accommodation By Persons With Disabilities JD-ES-264 Step 1: Enter the name of the person requesting accommodation in the first blank box. 

Connecticut Request For Accommodation By Persons With Disabilities JD-ES-264 Step 2: Enter your telephone number in the second blank box and the date or dates on which accommodation is needed in the third blank box.

Connecticut Request For Accommodation By Persons With Disabilities JD-ES-264 Step 3: Enter your full address in the fourth blank box.

Connecticut Request For Accommodation By Persons With Disabilities JD-ES-264 Step 4: Enter the case name or docket number, if known, in the fifth blank box.

Connecticut Request For Accommodation By Persons With Disabilities JD-ES-264 Step 5: Enter the location where accommodation is needed in the sixth blank box. You may enter your email address in the seventh blank box, but providing this information is optional.

Connecticut Request For Accommodation By Persons With Disabilities JD-ES-264 Step 6: Indicate whether the person is a juror, defendant, plaintiff, witness or other with a check mark. If other, describe.

Connecticut Request For Accommodation By Persons With Disabilities JD-ES-264 Step 7: Indicate whether the case is civil, criminal or other with a check mark. If other, specify.

Connecticut Request For Accommodation By Persons With Disabilities JD-ES-264 Step 8: Describe the nature of the disability that makes accommodation necessary in section I.

Connecticut Request For Accommodation By Persons With Disabilities JD-ES-264 Step 9: Describe how the disability affects a major life activity in section II.

Connecticut Request For Accommodation By Persons With Disabilities JD-ES-264 Step 10: Suggest the reasonable accommodation that is necessary in section III.

Connecticut Request For Accommodation By Persons With Disabilities JD-ES-264 Step 11: Enter any special requests or additional comments in section IV.

Connecticut Request For Accommodation By Persons With Disabilities JD-ES-264 Step 12: Enter your signature and the date at the bottom of the page. Send the form to the Americans With Disabilities contact person at the court location where the case will be heard.