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Submit by Email Richard S. K Becker Board C hair REASONABLE ACCOMMODATION REQUEST FORM Judith E. Ferry Board V ice C hair Tim O'Rourke Board 2nd V ice C hair Date: S tan Steele Board M ember M ark

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How to fill out reasonable accommodation request form

How to fill out a reasonable accommodation request form:

01

Start by obtaining the reasonable accommodation request form from the appropriate source. This could be your employer, school, or housing provider.

02

Read the instructions carefully to understand the requirements and the information that needs to be provided.

03

Begin by filling out your personal information, including your name, contact details, and any other identification information requested.

04

Clearly state the nature of your disability or medical condition that requires accommodations. Provide any relevant medical documentation or supporting evidence if required.

05

Specify the type of accommodation you are seeking. This could include modifications to your work environment, changes to work schedules, or adjustments to policies or procedures.

06

Describe the specific limitations or difficulties you face due to your disability, and explain how these limitations can be addressed through reasonable accommodations.

07

If applicable, indicate any specific accommodations you have in mind that will enable you to perform your job or access services or facilities effectively.

08

Sign and date the form, and ensure that you keep a copy for your own records.

09

Submit the completed form to the designated individual or department as instructed.

10

Follow up with the appropriate party to ensure that your request is being processed and to address any additional information or documentation that may be needed.

Who needs a reasonable accommodation request form:

01

Employees who require workplace accommodations due to a disability or medical condition.

02

Students who need accommodations to access educational facilities or programs.

03

Individuals seeking accommodations in housing or rental properties due to a disability or medical condition.

04

Any person with a disability who requires adjustments or modifications to existing policies, procedures, or programs in order to have equal opportunities and access to services and facilities.

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