Accommodation Request

Accommodation Request

First Name*

Last Name*

Employee ID*

Phone Number*

Spring ISD Email Address*

Campus/Department*

Select or enter value

Supervisor Email Address*

Duration of Accommodation (specify start and end dates):*

What, if any, job functions are you having difficulty performing due to your medical condition?*

What, if any, employment benefits (i.e. access to resources or tools) are you having difficulty accessing due to your medical condition?*

Describe how your medical condition limits your ability to perform your job or access an employment benefit*

Have you had any accommodations in the past for this same limitation or medical condition? If yes, what were they and how effective were they?*

What specific accommodation, if you know, will enable you to perform your job or access an employment benefit? (What specific accommodation do you need?)*

If you are requesting a specific accommodation, how will that accommodation assist you?*

Health Care Medical Certification Document:

Please upload the completed medical certification document completed by your physician. (Click Here) to access the form.

Drag and drop files here or

I confirm that the required medical certification document has been sent to my physician and will be forwarded to Human Resource Services once complete. I further understand that my request will not be considered complete until this document has been received by Human Resource Services.*

Send me a copy of my responses

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