Reasonable Accommodation Form

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Employee Information

Please enter your information
Please use your university issued email address

Specific Accommodation Information

What specific accommodation are you requesting?Required

Accessibility Accommodation

Is your accommodation request time sensitive?
Is this for a limited time?
What limitation (major life function) is interfering with your ability to perform your job?
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Have you had any accommodations in the past?
Has your limitation/disability been diagnosed by a Physician?
Upload supporting document(s)