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State of Wisconsin Office of State Employment Relations Division of Affirmative Action 345 W. Washington Ave. Madison, WI 53703 SAMPLE DISABILITY ACCOMMODATION REQUEST FORM Agency or UW System Unit:

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What is sample disability accommodation request?

A sample disability accommodation request is a document that an individual with a disability can use to request reasonable accommodations in order to have equal access to various activities, services, and programs.

Who is required to file sample disability accommodation request?

Any individual with a disability who requires accommodations to ensure equal access can file a sample disability accommodation request.

How to fill out sample disability accommodation request?

To fill out a sample disability accommodation request, you need to provide your personal information, describe your disability, specify the accommodations you need, and explain how the accommodations will facilitate your equal participation.

What is the purpose of sample disability accommodation request?

The purpose of a sample disability accommodation request is to formally request reasonable accommodations that will enable individuals with disabilities to have equal access, participation, and opportunities as others.

What information must be reported on sample disability accommodation request?

A sample disability accommodation request should include personal information, details about the disability, specific accommodations needed, and a description of how the accommodation will address the limitations of the disability.

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