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# IN THE COURT OF COMMON PLEAS OF ADAMS COUNTY, PENNSYLVANIA
Administrative Order
Number 3 of 2026
In Re: 51st Judicial District Americans with Disabilities Act (ADA) Title II Policy
## ORDER OF COURT
AND NOW, this 3^{rd} day of February, 2026, IT IS HEREBY ORDERED that Heather Wetzel shall serve as the Court ADA Coordinator as defined in the 51^{st} Judicial District Americans with Disabilities Act (ADA) Title II Policy (“Policy”). The Policy, originally adopted by Administrative Order 40 of 2014, may be updated from time-to-time without need for further Order of Court. The current version of this document is dated April 2024 and attached to this Order for reference purposes. The effective date of this Order shall be February 13, 2026, at which time Administrative Order 40 of 2014 shall be vacated.
BY THE COURT,
| Americans with Disabilities Act Accommodation (ADA) Title II Request for Reasonable Accommodation Form (Includes Request for Interpreter for Hearing/Speech Impaired) |
| Client Information - Section A |
| Name: _____ Phone: ☐ _____
Address: _____ Email: ☐ _____
Mobile: ☐ _____
Please place a check mark in the box for how you want to be informed of the status of your request.
Please check the box that most describes your status in this matter:
☐ Plaintiff ☐ Defendant ☐ Parent ☐ Child ☐ Witness ☐ Attorney ☐ Victim ☐ Juror
☐ Other (please explain) |
| Requestor Information - (if different from above) - Section B |
| Name: _____ Bus.Phone/ Mobile: _____
Address: _____ Fax: _____
Email: _____
Relationship to Client: _____ TTY: _____ |
| Accommodation - Section C |
| Accommodation Requested: |
| Location of Proceeding - Section D | Proceeding Information (if known) |
| ☐ Magisterial District Court No. _____ Case #: _____
District Judge Name: _____ Case Name: _____
☐ Criminal Division ☐ Civil Division ☐ Orphans' Court Division Judge: _____
☐ Family Division ☐ Adult ☐ Juvenile Proceeding Date: _____ Proceeding Time: _____
Specify Address: _____ Proceeding Type: _____ |
| AFTER COMPLETING THE FORM, PLEASE SEND TO: COURT ADA COORDINATOR, 117 Baltimore Street, 4th Floor, Gettysburg, PA 17325 Phone: (717) 337-9846, Fax: (717) 334-8817, Email: courtadacoordinator@adamscountypa.gov |
| I hereby certify that an Americans with Disabilities Act accommodation is required in the above-captioned action on the date stated.
Signature: _____ Date: _____ |
| FOR OFFICIAL USE ONLY |
| Service Provider Information - Section E |
| Service Provider Company: _____ Fax: _____
Individual Interpreter Name: _____ Email: _____ Date to:
Provider Name: _____ Provider: _____
Bus. Phone Mobile: _____ |
| Court Official Verification - Section F |
| Verifying Official Shall Maintain a Copy in the Court's Case File and Provide the Original to the Service Provider for Submission with Billing.
I hereby verify that the services were performed by the provider in the above-captioned action on the date and time stated. |
| Start Date & Time | End Date & Time |
| Court Official: _____ Signature: _____
Title: _____ Date: _____ | |
| (08/14) |
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| Date of Notice: |
| Person with a Disability Information |
| Name: | Home Phone\n(include area code): |
| Address: | Business Phone\n(include area code): |
| Mobile Phone\n(include area code): |
| Court Service, Program, Court Case or Proceeding Related to Request |
| Date of Service, Program, Court Case or Proceeding |
| Type of Accommodation Requested: |
| Request for Reasonable Accommodation:\n☐ Approved ☐ Alternate Accommodation Approved ☐ Request Denied |
| Type of Accommodation Approved: |
| Request for Accommodation was denied based on the following: |
|
|
| Grievance Procedure |
| The person with a disability, when an accommodation has been denied, may grieve the decision as a violation of the Americans with Disabilities Act to the President Judge of the 51st Judicial District. The grievance should be filed as soon as possible and no later than sixty (60) calendar days after the alleged violation. A Grievance Form may be obtained by contacting:\nAdams County Court Administrator\n117 Baltimore Street, 4th Floor\nGettysburg, PA 17325\n(717) 337-9846\n(717) 334-8817 (Fax)\ncourtadagrievance@adamscountypa.gov |
| Agency or Court: 51st Judicial District | Contact Person: |
| Address: 117 Baltimore Street, 4th Floor | Phone\n(include area code): (717) 337-9846 |
| Gettysburg, PA 17325 | Date Filed: |
| Signature: | Date: |
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## ADAMS COUNTY COURT OF COMMON PLEAS
| Americans with Disabilities Act (ADA) Title II Grievance Form |
| Grievant Information |
| Grievant Name: _____ | Home Phone (include area code): _____ |
| Address: _____ | Business Phone (include area code): _____ |
| Mobile Phone (include area code): _____ |
| Alternative Contact Person (other than Grievant) |
| Name: _____ | Home Phone (include area code): _____ |
| Address: _____ | 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? |
| Yes ☐ No ☐ If You Answered "YES" to the Previous Question, Complete the Following |
| Agency or Court: _____ | Contact Person: _____ |
| Address: _____ | Phone (include area code): _____ |
| Date Filed: _____ |
| Other Comments |
| Signature: _____ | Date: _____ |
| (08/14) |