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REASONABLE ACCOMMODATION REQUEST FORM The Tennessee Department of Transportation (TDOT) ensures that no person or groups of persons shall, on the grounds of race, color, sex, religion, national origin,
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Obtain a copy of the A-12TDOTReasonableAccommodationForm20190301.doc from the appropriate source.
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Open the form using a compatible software, such as Microsoft Word.
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Read through the instructions and guidelines provided at the beginning of the form.
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Fill in the required personal information, such as your name, contact details, and any applicable identification numbers.
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Follow the designated sections or fields to provide specific details about your accommodation request.
06
Clearly state the nature of your disability or medical condition that requires reasonable accommodation.
07
Describe the kind of accommodation you are seeking, whether it involves physical modifications, technological assistance, or any other necessary adjustments.
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Attach any supporting documentation or medical records that may be relevant to your request.
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Review the completed form to ensure all required information has been filled accurately.
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Sign and date the form to certify the authenticity of your request.
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This document is a form used to request reasonable accommodation for individuals with disabilities.
Any individual or organization requesting reasonable accommodation for individuals with disabilities is required to file this form.
The form should be filled out with detailed information about the individual needing accommodation and the type of accommodation requested.
The purpose of this form is to ensure that individuals with disabilities have equal access to services and opportunities.
The form should include information about the individual's disability, the requested accommodation, and any supporting documentation.
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