Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by completing the 'TO BE COMPLETED BY EMPLOYEE' section. Enter your name and title as a Rutgers University staff member.
3. Attach the essential functions of your position, which you can obtain from your supervisor, ensuring all necessary information is included.
4. In the brief description of the requested accommodation field, provide comprehensive details about the specific accommodations you are requesting.
5. Sign the 'Signature of Employee' line and enter the date of completion.
6. The next section is 'TO BE COMPLETED BY HEALTH CARE PROVIDER.' If applicable, ensure your health care provider fills out this section. They should include the date they first treated you and your diagnosis.
7. Ask the health care provider to specify which job functions you are having difficulty performing due to limitations, providing a clear description.
8. Encourage your health care provider to note any suggested accommodations that could assist in improving your job performance.
9. The provider should indicate the duration of any restrictions, marking whether they are temporary or permanent, along with the respective time frames.
10. Any additional comments from the provider should be included in the designated section for thoroughness.
11. The health care provider needs to print their name, specialty, address, and phone number, ensuring all provided information is clear.
12. The health care provider should sign and date the form. Once completed, ensure all sections are filled in accurately.
13. Finally, save changes to the form. You may download, print, or share the completed form as needed.

Take action now by filling out the form online to facilitate your accommodation request.