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  • American Disability Act Accommodation Request Form ...

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Dance with the Americans with Disability Act (ADA). Name Date of Request Campus Address Campus Phone Number Department Classification/Position Title Please answer the following questions to assist the agency in understanding the basis and nature of your request for accommodation. The information you provide will be treated confidentially and will be handled on a need-to-know basis. What are the essential duties and responsibilities of the position which will be or are affected by your disab.

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[Example 1] As a result of [Name]'s disability, she occasionally experiences episodes of disorientation and dizziness. During these episodes, [Name] must sit or lie down for a few minutes to recover. Therefore, [Name] needs, as an accommodation, permission to take these short breaks.

[Example 1] As a result of [Name]'s disability, she occasionally experiences episodes of disorientation and dizziness. During these episodes, [Name] must sit or lie down for a few minutes to recover. Therefore, [Name] needs, as an accommodation, permission to take these short breaks.

The Accommodation Form serves as the official notification to your instructors regarding your approved accommodations.

Dear [Insert employer's name here]: I am writing this letter to submit a request for accommodations in the workplace. I have pain in my lower back. Sitting or standing for long periods of time in the same position is causing increased pain and is decreasing my mobility.

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.

Change job tasks. Provide reserved parking. Improve accessibility in a work area. Change the presentation of tests and training materials.

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