Accommodation Planning Requests

You can contact Caroline Knuth by email at cknuth@lps.org or by phone at 402-436-1000.

Upon completing this form, you will receive an automatic email acknowledgment. After we receive your request, someone will from our office will make contact with you within a few business days.

First Name

Last Name

Birth Date

mm/dd/yyyy

LPS Email Address

Personal Email Address

Contact Preference

Home Address

City

State

Zip

Personal Phone Number

Building/Department

Accommodation Request

What is the condition for which you are requesting an accommodation?

Position Title

Additional Information

Please list the accommodations or items you believe would be reasonable and helpful in allowing you to perform the essential functions of your position

Send me a copy of my responses

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