Request for Accomodations Form

Please complete the following form to help us determine the best course of action for your accommodation requests for the 2024-2025 school year.

Once you have completed this form, a member from the HR team will reach out, via email, to begin the interactive process.

Please note, there will be a form emailed to you. This form must be completed and returned within 15 days or your request will be considered cancelled.

Today's Date

mm/dd/yyyy

First Name

Last Name

Site/Department

Phone Number

Phone

Position/Job Title

Supervisor's Name

Supervisor's Email

Accommodation Request

Please describe the nature, extent and duration of your disability/request.

You will receive a form for your medical provider to fill out and return. Once the form is returned, an HR team member will reach out to you directly to discuss your request and work with you and your supervisor through an interactive process.

Duration

Please select 'Temporary' if you need short-term accommodations.

Please select 'Permanent' if you need long-term accommodations.

File upload

Optional: Please upload any medical documentation that pertains to your request.

Drop your files here

Send me a copy of my responses

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