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MassachusettsInstituteofTechnology HumanResourcesOffice 77MassachusettsAvenue,E19215 Cambridge,MA02139 Fax:617.253.1502 TTY:617.258.9344 Employee Reasonable Accommodation Request Form Name: Dept.:
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How to Fill Out a Reasonable Accommodation Request Form.docx:

01
Start by opening the Reasonable Accommodation Request Form.docx on your computer or device.
02
On the first line, enter your full name as it appears on official documents.
03
Next, provide your contact information, including your phone number, email address, and mailing address.
04
Indicate the date on which you are submitting the form.
05
In the "Reason for Request" section, specify the nature of your request for a reasonable accommodation. Clearly explain why you need this accommodation and how it relates to a disability or medical condition.
06
If applicable, provide any supporting documentation or medical records that can help support your request for accommodation.
07
In the "Requested Accommodation" section, detail the specific accommodation you are seeking. Be as specific as possible, outlining what modifications or adjustments you need to perform your job or participate in a program or activity.
08
If needed, include any additional information or details that may be relevant to your request.
09
Read the "Certification" section carefully and sign and date the form to acknowledge that the information provided is accurate to the best of your knowledge.
10
Make a copy of the completed Reasonable Accommodation Request Form.docx for your records.
11
Submit the form as instructed, whether it's through an online portal, email, or by mailing it to the appropriate department or individual responsible for handling accommodation requests.

Who Needs Reasonable Accommodation Request Form.docx?

01
Employees or job applicants with disabilities who require accommodations to perform essential job functions.
02
Individuals with disabilities who need accommodations to participate in programs or activities provided by organizations or institutions.
03
Students with disabilities who require academic or testing accommodations.
04
Individuals accessing government services or programs who need accommodations due to a disability.
05
Any individual who believes they are entitled to a reasonable accommodation under the law should use the Reasonable Accommodation Request Form.docx to formalize their request and initiate the accommodation process.
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The reasonable accommodation request formdocx is a document used to request accommodations for individuals with disabilities in order to ensure equal access and opportunities.
Any individual with a disability who requires accommodations in order to participate in programs or activities.
The form should be completed with the individual's personal information, a description of the requested accommodation, and any supporting documentation.
The purpose of the form is to provide individuals with disabilities the opportunity to request accommodations that will allow them to fully participate in programs or activities.
The form should include the individual's name, contact information, nature of the disability, requested accommodations, and any supporting documentation.
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