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EMPLOYEE REQUEST FOR ACCOMMODATION UNDER THE AMERICANS WITH DISABILITIES ACT (ADA) Purpose: Form ADA99 is used by an employee to submit a request for accommodation. Processing Procedures: 1. The employee.

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I learned in our conversation on [date], that you have a health condition that may impact your ability to perform your job. I want you to have the opportunity to be successful in your job and encourage you to work with us in identifying reasonable accommodation, if needed, which will provide this opportunity.

The health care provider's note that you provided to us on [date] stated that you have the following work restriction(s): [list restrictions]. We met with you to discuss possible accommodations needed because of these restrictions on [date]. We have approved the following accommodation(s): [list accommodations].

Content to consider in body of letter: Identify yourself as a person with a disability. State that you are requesting accommodations under the ADA (or the Rehabilitation Act of 1973 if you are a federal employee) Identify your specific problematic job tasks. Identify your accommodation ideas.

Dear Mr./Ms. (Contact at Human Resources Department): I work at ________(Company Name) as a ________(Your Job Title) and have been in this position since ____ (Date). I am writing to request that you provide __________________(list accommodation needed here) as a reasonable accommodation under the ADA.

Consistent with the Americans with Disabilities Act (ADA) and [insert state civil rights law], it is the policy of [Employer] to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship.

Because of my disability, I need the following accommodations: [LIST ACCOMMODATIONS]. A medical provider has prescribed this accommodation for my disability. I would like to meet with you to discuss these and any other accommodations that will enable me to have an equal opportunity to live in and enjoy this residence.

Sample Accommodation Request Letter: Mental Health I have been having medical issues that have affected my mood, sleep schedule, concentration, and focus. I would like to request accommodations so that I might be able to perform my job effectively before my performance starts to suffer.

Content to consider in body of letter: Identify yourself as a person with a disability. State that you are requesting accommodations under the ADA (or the Rehabilitation Act of 1973 if you are a federal employee) Identify your specific problematic job tasks. Identify your accommodation ideas.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232