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Court Facilitator Appointment Request Form

  1. Are you already working with the Court Facilitator?*
  2. If yes, please skip the following questions and type what you need assistance with in the text box below.
  3. Do you receive State assistance?
  4. Are you/have you been represented by an attorney?
  5. Do you need an interpreter?
  6. Do you have an existing case?
  7. Once this form is received, the Court Facilitator will reach out to you by email as soon as possible. Please be sure to check your junk/spam folders. You will need to follow the instructions in the email in order to schedule an appointment.
  8. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) you have read the disclaimer and policies above this form and would like to proceed with Court Facilitator assistance, 2) your application will not be signed in the sense of a traditional paper document, 3) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 4) you may still be required to provide a traditional signature at a later date.

  9. Leave This Blank:

  10. This field is not part of the form submission.