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Request for Reasonable Accommodations×Modifications To: Accommodation Coordinator Housing Authority Address From: Applicant or Resident Name (please print) Control Number Address Town×City, State,
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How to fill out a request for reasonable accommodations/modifications:

01
Start by downloading or obtaining the request form for reasonable accommodations/modifications from the appropriate organization or institution.
02
Fill out the personal information section of the form, providing your full name, contact details, and any other required information.
03
Clearly state the nature of the accommodations or modifications you are requesting. Be specific and detailed in describing your needs.
04
Provide any necessary supporting documentation or medical records that justify your request. This can include letters from healthcare professionals, diagnostic reports, or any other relevant evidence.
05
Explain the impact of your disability or condition on your ability to perform certain tasks or access certain facilities. Clearly outline the limitations and difficulties you face.
06
List any previous accommodations or modifications you have received, if applicable, and explain why they may no longer be sufficient or why new accommodations are necessary.
07
Indicate the duration of the requested accommodations or modifications. Specify if they are needed permanently or temporarily.
08
If needed, suggest potential accommodations or modifications that you believe would meet your needs. However, it's important to remember that the final decision lies with the organization or institution responsible for granting the request.
09
Sign and date the request form, certifying that the information provided is true and accurate.
10
Submit the completed request form along with any required supporting documents to the appropriate department or individual within the organization or institution.

Who needs a request for reasonable accommodations/modifications?

01
Individuals with disabilities or medical conditions that require specific accommodations or modifications.
02
Students who require accommodations or modifications to participate fully in educational programs.
03
Employees who need adjustments in the workplace to perform their job duties effectively.
04
Individuals who need modifications to access public facilities or services.
05
Patients who require accommodations or modifications in healthcare settings to receive appropriate care.
06
Anyone who, due to a disability or medical condition, faces limitations or barriers that can be reasonably addressed through accommodations or modifications.
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A request for reasonable accommodations/modifications is a formal request made by an individual to make changes or adjustments to policies, practices, or procedures in order to provide equal access and opportunities.
Any individual who requires accommodations or modifications in order to participate in a program or activity may file a request for reasonable accommodations/modifications.
To fill out a request for reasonable accommodations/modifications, the individual needs to provide information about the specific accommodation or modification needed, along with any supporting documentation.
The purpose of a request for reasonable accommodations/modifications is to ensure that individuals with disabilities have equal access and opportunities in programs and activities.
The request for reasonable accommodations/modifications must include the specific accommodation or modification needed, the reason for the request, and any supporting documentation.
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