New Jersey Reasonable Accommodation Request Form

State:
Multi-State
Control #:
US-216EM
Format:
Word; 
Rich Text
Instant download

Description

This form may be used to assist a company in determining to what extent a reasonable accommodation is required.
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FAQ

I have been working in (Branch) since (Duration) holding employee ID (Employee ID). Through this letter, I would request you to kindly provide me with accommodation. I, on // (Date) got transferred to (Branch Address) branch and have no place to reside at.

Accommodations are typically grouped into four categories: presentation, response, setting, and timing and scheduling.

I would like to request accommodations for your class. I have copied my coordinator (name) and have attached my verification letter. I would like to set up a time to discuss this information with you to determine how we can implement accommodations. Please let me know your convenient time.

According to the EEOC, you only have to let your employer know that you need an adjustment or change at work for a reason related to a medical condition. You can use "plain English" to make your request and you do not have to mention the ADA or use the phrase "reasonable accommodation."

In your reasonable accommodation letter, you should provide all the information your employer will need to begin the accommodation process, including what your disability is, how it affects you, which aspects of your job might require modification, and proposed accommodations.

Re: Request for Reasonable Accommodation for (Your Name)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.

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.

Steps for Requesting AccommodationsComplete a Getting Started Form. This basic form consists of contact information and five brief questions.Provide DSS with current disability related documentation.Meet with DSS for an intake appointment.Request Your Accommodations Each Term.

Accommodation is a means of preventing and removing barriers that impede students with disabilities from participating fully in the educational environment in a way that is responsive to their own unique circumstances. The principle of accommodation involves three factors: dignity, individualization and inclusion.

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New Jersey Reasonable Accommodation Request Form