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10/09 REASONABLE ACCOMMODATION REQUEST FORM (please forward initially to the ADA Coordinator of your Agency) Day Phone # (Voice) (ODDITY) CS-388A NAME: Please print Last Name, First Name, MI Soc Sec
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How to fill out reasonable accommodation request form
How to fill out reasonable accommodation request form:
01
Start by providing your personal information, including your name, contact information, and any relevant identification numbers.
02
Clearly state the reason for your request for reasonable accommodation, providing specific details and examples to support your case.
03
Indicate the type of accommodation you are requesting and explain how it will help you perform your job or access the services you need.
04
If applicable, attach any supporting documents, such as medical records, assessments, or recommendations from healthcare professionals.
05
Sign and date the form, acknowledging that the information provided is true and accurate to the best of your knowledge.
Who needs reasonable accommodation request form:
01
Individuals who have a disability or a condition that may require accommodations in the workplace or in accessing public services.
02
Employees who are experiencing limitations or difficulties in performing their job duties due to their disability.
03
Students or individuals accessing services who require accommodations to ensure equal access and participation in educational or public programs.
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What is reasonable accommodation request form?
A reasonable accommodation request form is a document that individuals can use to request certain accommodations or modifications in a variety of settings, such as employment, education, or housing, to accommodate their disabilities or medical conditions.
Who is required to file reasonable accommodation request form?
Any individual with a disability or medical condition who requires accommodations or modifications to participate fully in a program, service, or activity may be required to file a reasonable accommodation request form.
How to fill out reasonable accommodation request form?
To fill out a reasonable accommodation request form, individuals typically need to provide their personal information, describe their disability or medical condition, explain the specific accommodations or modifications needed, and provide any supporting documentation or medical records.
What is the purpose of reasonable accommodation request form?
The purpose of a reasonable accommodation request form is to ensure that individuals with disabilities or medical conditions have equal access to opportunities and are provided with necessary accommodations or modifications to participate fully in various programs, services, or activities.
What information must be reported on reasonable accommodation request form?
The information required on a reasonable accommodation request form may include personal details, the nature of the disability or medical condition, the specific accommodations or modifications needed, and any supporting documentation or medical records.
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