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NOTE: This template is an example only. Providers should modify it to fit their specific needs. There is also a statement at the end of this document for those providing Incident supervision. Sample
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How to fill out reasonable accommodations and modifications

01
Contact the appropriate office or department at your school, workplace, or organization to request a reasonable accommodation or modification.
02
Provide documentation of your disability or medical condition, outlining the specific accommodation or modification needed.
03
Meet with a representative to discuss potential accommodations and modifications that can be put in place.
04
Agree on the appropriate accommodations and modifications with the representative and ensure they are implemented in a timely manner.
05
Evaluate the effectiveness of the accommodations and modifications, and make adjustments as needed.

Who needs reasonable accommodations and modifications?

01
Individuals with disabilities who require support to participate fully in educational or work-related activities.
02
Individuals with medical conditions that impact their ability to perform certain tasks or access facilities.
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Reasonable accommodations and modifications are changes made to policies, practices, or procedures to ensure equal access for individuals with disabilities.
Employers, landlords, and service providers are required to provide reasonable accommodations and modifications for individuals with disabilities.
To fill out reasonable accommodations and modifications, individuals must request the necessary changes in writing and provide documentation of their disability.
The purpose of reasonable accommodations and modifications is to eliminate barriers and ensure equal opportunities for individuals with disabilities.
Information that must be reported on reasonable accommodations and modifications includes details of the requested accommodation, documentation of the disability, and any agreed upon changes.
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