Uic Employee Request For Reasonable Accommodation Based On Religious Reason - Office For Access And Equity Page 2

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SECTION 2: COLLEGE/UNIT/DEPARTMENT REVIEW
(
To Be Completed By Employee’s Supervisor or Human Resources Representative)
First Name
Last Name
Phone Number
Email
Job Title/Classification
Evaluation of Impact to College/Unit/Department (if any)
Date Discussed with Employee
Decision (Approved/Modified/Denied)
Accommodation Agreed Upon (explanation)
Supervisor Signature
Human Resources Signature
Date
Date
SECTION 3: FINAL DECISION
(
To Be Completed By the Office for Access and Equity)
1. Request is:
Approved
Modified (explanation)
Denied
OAE Representative Signature
Date
2
Revised November 2016
| 312.996.8670

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