Complete this form to request a religious accommodation, Title IX accommodation (pregnancy, lactation) or an accommodation for a disability or medical condition. Individuals who are employed at the University of New Mexico and are requesting reasonable accommodation(s) under the Americans with Disabilities Act of 1990 (ADA) and the ADA Amendments Act of 2008 (ADAAA) are encouraged to complete this form in its entirety.

If you are unable to complete this form on your own, someone else may complete the form on your behalf. Completed documentation are to be returned to the Director of the Office of Equal Opportunity, University of New Mexico located at 609 Buena Vista Dr NE.

NOTE ON PROTECTED HEALTH INFORMATION (PHI)

Please DO NOT include any PHI in this request. You will be contacted to discuss the details of your request and can provide that information to us then.

**PHI is information found in medical records or designated record sets that can be used to identify an individual.

FOR STUDENTS REQUESTING AN ACADEMIC ADJUSTMENT FOR A DISABILITY OR SERIOUS MEDICAL CONDITION: Please DO NOT use this form to request an accommodation if you are a student with a disability or serious medical condition who needs a classroom adjustment for a course you are taking. The UNM Accessibility Resource Center handles ADA accommodation requests for students who need an adjustment for academic purposes (tests, lectures, materials, learning, etc.). You can learn more about how to request this type of accommodation through the following link: https://arc.unm.edu/students/how-do-i-request-my-accommodations-for-the-semester.html.