Confirmation Of Request For Reasonable Accommodation
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4CONFIRMATION OF REQUEST
FOR REASONABLE ACCOMMODATION
1.
Applicant’s or Employee’s name:
2.
Applicant’s or Employees phone number:
3.
Date of request:
Employees Office:
4.
:
Accommodation requested
(be as specific as possible, e.g., adaptive equipment, reader,
interpreter, working space modification, etc.)
5.
Reason for the request:
(if the accommodation is time sensitive, please explain):
(Return form to Disability Program Manager)
(Disability Program Manager will assign number)
6.
.
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Parent category: Business