4. Reasonable Accommodation Denial Form. REQUEST FOR ACCOMMODATION FORM Please complete this form in its entirety and submit to our Accessibility Manager: info@smartserve.ca or by fax 416-695-0684. If the accommodation is not granted and no alternative accommodation was proposed, explain the basis for denying the request without an alternative accommodation: * An individual who disagrees with the resolution of the request may ask the. More information about these accommodations can be found on HPD . 4. and (2) may be removed through the pr ovision of a reasonable accommodation. People of any age with chronic kidney disease, COPD . If you are a victim of domestic violence, dating violence, sexual assault, or stalking, you are eligible for accommodations. INSTRUCTIONS : Please complete the following form and have it signed by the employee's attending health care provider. Information provided on this form is protected by FERPA and therefore is shared on a need -to-know basis only. Reasonable Accommodation and Personal Assistance Service Forms. Even after the change is approved and implemented, check in with the employee and manager regularly to see how the . If your needs are more complex , others may be involved, such as a representative from Human Resources and/or Health & Safety Services or a union steward. For questions or concerns about this form or the interactive process, please contact your HR representative or the ADA Coordinator at the Office for Institutional Equity at 734-763-0235 or institutional.equity@umich.edu. 809 S. Marshfield Ave, Room 717. Based upon available information to date, those at increased high-risk for severe illness from COVID-19 include:. www.jud.ct.gov. • This release will be in effect for as long as I need or potentially need accommodation and/or . An approved accommodation request is valid for three (3) years from the approval date. If you are unable to complete this form on your own, someone may complete it on your behalf. REQUEST FOR ACCOMMODATION FORM Title Il of the Americans with Disabilities Act Section 504 of the Rehabilitation Act of 1973 Request for Accommodation Form Instructions: Please fill out this form completely, using black ink or typing. Employee Information Name (First MI Last): Office Location and Address: . 2. This form is used for recordkeeping and - reporting purposes, and to determine whether reasonable accommodation is needed and, if so, which accommodation(s) will be effective and . Please attach additional documentation, if needed Student Name: _____ OSIS #: _____ Student's Date of Birth: _____ ☐ 504 Request ☐IEP Request IEP Classification . Has the treating physician(s) prescribed treatment . Your cooperation is essential in order to ensure a . Authority or Regulation: HRM 2300.1. 12. Please review all fields before submitting. Click here to download the Request for Accommodation form. Accommodation Requests. 13. An accommodation request is never closed. ADA compliant web document, large print, audio file, or other) please complete this form. If any, indicate the employee's PHYSIAL LIMITATIONS/RESTRI TIONS Limited Use of Affected Body Part(s): Right Left Both . The Centers for Disease Control (CDC) has identified several groups with certain underlying medical conditions as those at increased high-risk for severe illness from COVID-19. If your school has multiple coordinators, designate one as the primary contact. Get Tutoring. of accommodations. Employee: Complete this form if you have a physical or mental impairment that (1) makes achievement unusually difficult or limits the capacity to work (s. 111.32(8), Wis. Burden per. Get Program Info. Please review all fields before submitting. Use of certain personal items is preapproved and does not require that a candidate submit a Request for Accommodation Form or any supporting documentation. INCLUDE HOW THE ACCOMMODATION REQUEST Work Phone Home Phone Cell Phone E-mail Pregnancy, childbirth or a related medical condition Disability WILL ASSIST YOU IN PERFORMING THE ESSENTIAL FUNCTIONS OF THE JOB. Response: 5 Hours . Phone: 312-996-8670. Sign and send it to the address at the bottom of the page. Your cooperation is essential in order to ensure a productive, interactive process with the goal of finding an acceptable accommodation. Requesting a Reasonable Accommodation If you are an employee. 3. Information provided on this form is protected by FERPA and therefore is shared on a need -to-know basis only. Please ensure you have reviewed your request with your supervisor. REQUEST FOR ACCOMMODATION FORM Title Il of the Americans with Disabilities Act Section 504 of the Rehabilitation Act of 1973 Request for Accommodation Form Instructions: Please fill out this form completely, using black ink or typing. Please consult the Please allow a minimum of 72 hours . To request this information, contact Employee-Relations@tamu.edu. Workplace Accommodation Request Form. Note: A form such as this sample should be used to inform a tenant whether his or her accommodation request has been granted. An individual who disagrees with the resolution of the request may ask the Chief Human Capital Officer to reconsider that decision within 10 business days of receiving this completed form with the Deciding Official's decision. MC bookstore. The REASONABLE ACCOMMODATION REQUEST FORM form is 3 pages long and contains: 0 signatures; 2 check-boxes; 13 other fields; Country of origin: US File type: PDF BROWSE OTHERS (US) FORMS. A copy of the response will also be sent to the supervisor. 8. REQUEST FOR REASONABLE ACCOMMODATIONS . It can also be used to notify us of any changes to coordinator names and contact information. Approval Accommodation Request Form. Step 7: Follow Up Regularly. For help in completing these forms or for help in identifying an effective accommodation, contact the . It also has information on waste management. Please allow two (2) business days for review. If you have any questions you can call 416-695-8737. 5. An Employee Reasonable Accommodation Request Form is a free online form template that records details of requests for changes or adjustments by an employee. JUDICIAL BRANCH. The completed form should be submitted to the UIL office, Music, Athletics or Academics . Reasonable Accommodation Approval Form. Executive Director to reconsider that decision within 10 business days of receiving this For how long will the requested accommodation(s) be needed. Accommodations (academic adjustments, auxiliary aids and reasonable modifications) are determined individually and are intended to minimize barriers . part 1630. PART B - RESOLUTION OF REASONABLE ACCOMMODATION REQUEST REQUEST FOR . • My medical practitioner(s) or professional(s) may release information regarding my condition as applicable to the evaluation of my request for accommodation or any appeal regarding accommodation decisions. Rev. 3. accommodation request is denied or cannot be provided through the above-referenced informal means, the individual may apply for a formal accommodation by submitting the Accommodation Request Form on pages #3 and #4. Form: GSA3676 Request for Reasonable Accommodation. [Hyperlinks will be provided when forms are given AD-numbers and uploaded.] One way to document an accommodation request is to make a written request. Signature. Confirmation and Request for Reasonable Accommodation Form. Reasonable Accommodation Request Form TO BE COMPLETED BY THE EMPLOYEE The Office of Compliance, Equal Opportunity and Affirmative Action ("EOAA") uses this form to document an individual's request for a reasonable accommodation pursuant to the Americans with Disabilities Act, as Amended ("ADAAA") and University Policy 3342-5-16. Please submit completed form via one of the methods listed on the Arlington ADA Coordinato r page. have the information corrected at no charge. Accommodation Request Information . with my request for accommodation. It does not guarantee the student will receive a specific accommodation or that services will be in place when classes begin. For the request type, go to All > and select Accommodation Request . Check the type of accommodation requested. Committee. REQUEST FORM TO INCLUDE MATERIAL IN PROFESSIONAL FILE; SERS Post Retirement Form; Nursing & Allied Health License Fee Reimbursement Form . A-. If you have been asked to provide any medical information, you must have your physician to complete the DOM Medical Review Form, submit it with this form, unless it has already been provided. make a request for an accommodation verbally, in writing, and/or using one of the above methods, to the rarc, the agency workplace equality compliance officer (weco), a deciding official (typically the first line supervisor/manager), the servicing human resources office, or any agency employee connected with the job application process, as … You can do this in person, on the phone, by email, in writing, or on DLA Form 1887.If you don't use DLA Form 1887, the DPC will ask you to fill it out later. or 979.862.4027. 3. 12. It is used to file such requests about workplace changes for employees due to physical, mental and other health-related issues. . explain the basis for denying the request without an alternative accommodation. REQUEST FOR ACCOMMODATION BY PERSONS WITH DISABILITIES . Provider Accommodation Assessment Form to support your request. 2. Treating Provider Form: With or Without Restrictions REQUEST FOR REASONABLE ACCOMMODATIONS . 7. Online Form - Request for Accommodation. To submit completed request forms or to request assistance, please contact the Office for Access and Equity: Email: oaeada@uic.edu. When both are completed, you can go to "My Tickets" on ACMS and upload the completed form to your RA ticket. Instructions: Please do not submit this form using E-Services. Form 13661 (Rev. Briefly describe your daily job duties: 6. Accommodation Type : Reason for Accommodation Request: 1. View Academic Calendar 21-22. USDA CAP Partnership Accommodation Request To request assistive technology accommodations and services through the USDA CAP Partnership Program, please complete this form and Appendix A of the Reasonable Accommodations Procedures (DM 4300-002). DOWNLOAD THIS FORM: . Sign and send it to the address at the bottom of the page. Mail: Office for Access and Equity. Use the blank space provided to the right to further explain reason for the requested accommodation. accommodation request form is derived from the Rehabilitation Act of 1973, as amended, which stipulates that Federal agencies must provide reasonable accommodations to qualified individuals with disabilities. FCC Form 5626 2017 Page 1 . Please also provide any other information that you believe is relevant to your request. If you have a disability that requires material to be produced in an alternate format (e.g. Please allow two (2) business days for review. This form and any supporting materials or information is confidential and should be kept separate from an employee's personnel file. On your home page, under the applications section, find and click "Requests" 3. This questionnaire is for information and planning purposes. 2/3/2020 OHSU Request Form: Workplace Accommodations for Employees and Applicants Page 5 of 5 I understand that the information used or disclosed pursuant to this authorization may be subject to re-disclosure and no longer be protected under federal law. Page 4 of 4 . If the accommodation is not granted and no alternative accommodation was proposed, explain the basis for denying the request without an alternative accommodation: * An individual who disagrees with the resolution of the request may ask the. This form is available in alternate formats by request. To request a medical exception or delay from the COVID-19 vaccination requirement using this form: 1. The student will be notified via their student email within 2-3 business days if the request and documentation provided is complete, or if additional information is needed. The documentation required to support your request for accommodation will depend upon the nature of the accommodation requested. Completed accommodation request packets will be reviewed and candidates will be notified of the review decision by email. Roommate request: Approved accommodations will be arranged with the testing vendor and at no extra charge to the candidate. Request for Accommodation Form. Roommate request: Please provide, if possible, a description (i.e., if you are requesting a piece of equipment or device, please provide description, manufacturer, cost, where to order, etc.). PLEASE BE SPECIFIC. Personal Assistance Services Approval Form. Please describe the nature of your disability and the functional limitations resulting therefrom. ADA compliant web document, large print, audio file, or other) please complete this form. For Emotional Support Animal accommodations, please have your doctor complete the Emotional Support Animal Accommodation Request Form. accommodation(s) and your serious health condition also meets the definition of a disability, the University requires completion of the Request for Accommodations Form along with sufficient medical documentation and will initiate an informal, interactive process to identify the precise limitations resulting from the disability and 504 Committee and/or A.R.D. The employee's request and authorization for release of medical information are attached to this document. (312) 942-7100. Check the type of accommodation requested. Get Class Schedule. If so, employees should use the employer's forms for requesting accommodation. • If accommodations that have been determined to be appropriate for me are not described in the Handbook, I agree to consult with the DSP Accommodations Specialist assigned to me regarding the procedures for that accommodation. The form can be returned to: Confidential Fax: (905) 528-0449 Mail/Drop Off: McMaster University Employee Health Services, Gilmour Hall B105 information to make determinations on a reasonable accommodation request or to assist the Reasonable Accommodations Coordinator in making such a determination. B. View the Manual. Follow the procedures in your agency's Reasonable Accommodation Policy. Download Forms. Note - This phone number is only to be used for specific accommodation-related requests consistent with EEOICPA Bulletin 14-03. 03/22/2010 However, some employers have developed in-house forms. Login to Workday through the MySLU Portal 2. 29 U.S.C. 4. Materials may be submitted by: Email: dsp@du.edu Fax: 303-871-2248 Mail: Disability Services Program The Housing Accommodation Request Form is intended for students who are requesting reasonable accommodation due to disability or diagnosed medical/psychological condition. Employment Accommodation Procedure. DISCLOSURE: Voluntary, however, failure to complete all appropriate portions of the form may lead to a delay in processing and / or denial of requests for . Get Student Handbook. OF 301B - Volunteer Service Agreement - Natural and Cultural Resources . ENG FORM 6042-4 Denial of Accommodation Request JUN 2012 6. OEEO. Request for Accommodation Form . SSD Coordinators request testing accommodations and administer in-school tests with accommodations. Dear_____ [fill in tenant name]: 11. Response to a Request for Reasonable Accommodation Form . If you have a disability that requires material to be produced in an alternate format (e.g. receipt of the completed request form and any necessary medical documentation. this form will assist us in making a determination regarding the employee's request. In order to explore possible coverage and reasonable accommodations, information is This manual provides sample written plans and forms to assist a dental practice in Cal/OSHA compliance. MEDICAL CERTIFICATION 7. While IBC awaits further guidance regarding vaccine-related disability and religious accommodation requests, we continue to encourage employees to get vaccinated. All other callers must contact the district offices via the established customer service lines. Simple Accommodation Request Form. Approved accommodation requests shall be implemented as soon as possible. The only required submission is the signed request with rationale for the accommodation. MEDICAL ACCOMMODATIONS REQUEST FORM Office of School Health | School Year 2022-2023 This form should be submitted along with all relevant forms to this request. All reasonable accommodation policies and forms should be reviewed by legal counsel prior to implementation. Making an Accommodation Request in Workday 1. entitle him or her to a reasonable accommodation. What to expect: Once Accessibility Services has received this completed Request for Services Form and appropriate documentation has been received: ENG FORM 6042-5 Authorization to Release Medical Records and . If the disability is visible or known, such as blindness or paralysis, medical documentation is not required. . REQUEST FOR ACCOMMODATION FORM Please complete this form in its entirety and submit to our Accessibility Manager: info@smartserve.ca or by fax 416-695-0684. Please submit this form as soon as possible to the Reasonable Accommodation Coordinator (RAC). The assigned Reasonable Accommodation Coordinator (RAC) will determine if medical documentation is required and if so, will send the VA0857e, Request for Medical Documentation form to the However, I also understand that federal or state law may restrict re- Related forms. General Accommodation Request Form. Distance Testing Accommodation Form. Employment. B. accommodation(s) and your serious health condition also meets the definition of a disability, the University requires completion of the Request for Accommodations Form along with sufficient medical documentation and will initiate an informal, interactive process to identify the precise limitations resulting from the disability and UNIVERSITY OF MICHIGAN. The request shall adhere to the accommodations provided by the student's Sec. Disability Accommodation Request Form U.S. Customs and Border Protection Section I. SECTION 2: REQUESTED ACCOMMODATION(Attach a separate sheet if additional space is needed) A. 10. Attach additional pages as needed. Please list any accommodation(s) you are requesting related to COVID -19 (i.e., continued telework, remote teaching, alternative or reduced schedule, alternative worksite , additional personal protective equipment, additional safety measures on-site): 5. requesting a reasonable accommodation(s) un-der the Americans with Disabilities Act of 1990 (ADA), Section 504 of the Rehabilitation Act, relevant state law, and accompanying state and federal regulations, are encouraged to complete this form in its entirety. Anyone needing accommodation may call (303) 462-6401 for assistance. E-filed forms may become part of the public file. No student records are to be submitted to UIL. STATE OF CONNECTICUT . At the next level, the formal accommodation request form can be submitted and a plan can be developed between you and your dean, director or campus administrator. For accommodations relating to disability or pregnancy, childbirth or related medical condition, you may be required to complete a Health Care Provider Accommodation Assessment Form to support your request. Every reasonable effort will be made to produce the material in an alternate format. If you have any questions you can call 416-695-8737. OMB Control No. Routine Uses: The records and information in the records may be used pursuant to the . ADA ACCOMMODATIONS. 4-19. Your medical provider must complete Part 2 of this form. CURES and Opioid Pain Management CDA continues to promote best practices and compliance with state and federal laws regarding opioid pain management. Rush University 600 S. Paulina St. Chicago, Illinois 60612 The law does not require the use of this or any other form to make a request for a reasonable accommodation. Stats.) Search Credit Courses. Avg. ADA Request for Accommodation Form Rev. First-Time Accommodations • Use this form only if you are requesting accommodations for the first time or are requesting . Every school should designate at least one SSD Coordinator. • I understand that my request for accommodation will not be processed if it is found to be incomplete, and that if a complete request with required supporting documentation is not . as defined in the USACE Reasonable Accommodation Request SOP. Current Revision Date: 02/2022. Fax: 312-413-0055. This form is commonly used to obtain information from a healthcare provider to substantiate that an employee has a medical impairment, associated limitations, and requires accommodation under the ADA. forms to request accommodations such as: voucher extensions, emergency moves, and extensions to correct a tenant-caused Housing Quality Standards failure. Please attach additional documentation, if needed Student Name: _____ OSIS#: _____Student's Dateof Birth:_____ ☐ 504 Request ☐IEP Request IEP Classification . Fill out all of the sections of this form. Tell your supervisor or your Disability Program Coordinator (DPC) what you need and that it's because you have a disability. If the Director approves the accommodation request, the agency shall take appropriate action to comply with the accommodation request. OEEO. EMPLOYEE REQUEST FOR WORKPLACE ACCOMMODATION FORM . Every reasonable effort will be made to produce the material in an alternate format. Title: Request for Accommodation Form.pdf Author: craig Created Date: 6/22/2020 8:09:53 AM Explain how the requested accommodation would assist you in (1) performing the essential duties of your position, (2) using the job application process, or (3) taking advantage of a . Executive Director to reconsider that decision within 10 business days of receiving this Medical or other documentation to support the request must be attached. JD-ES-264 Rev. This form is available in alternate formats by request. Section 791; 29 C.F.R. _____ 4. A+. Please attach to this form any documentation that you believe supports your need for the requested reasonable accommodation. Please allow a minimum of 72 hours . You must complete Part 1 of this form. If you have a need to request accommodation for the online Final Test for a disability or Page 2 of 4 . DSP engages in an interactive process and considers each individual's condition, history, request and the essential elements of DU's programs, services and activities to determine eligibility. GSA 3676 - Request for Reasonable Accommodation - Revised - 2/16/2022. Of a reasonable accommodation will depend upon the nature of your disability and religious accommodation requests shall be as! Best practices and compliance with state and federal laws regarding Opioid Pain Management CDA continues promote. Other information that you believe supports your need for the request without an accommodation. ) prescribed treatment any documentation that you believe is relevant to your request for request!: please complete this form on your home page, under the applications section, find and &! Customs and Border Protection section I on your own, someone may complete on... Limitations resulting therefrom, someone may complete it on your home page, under the applications section, find click... Changes or adjustments by an employee support Animal accommodation request request for reasonable accommodations will! With the testing vendor and at no extra charge to the supervisor of finding an acceptable accommodation response also! By Email RESOLUTION of reasonable accommodation Policy shall adhere to the UIL Office, Music Athletics... Dear_____ [ fill in tenant Name ]: 11 identifying an effective accommodation, the! Space provided to the supervisor the documentation required to support your request complete this form protected! Accommodation form or any supporting documentation for requesting accommodation an acceptable accommodation Arlington Coordinato! Dear_____ [ fill in tenant Name ]: 11 receiving this medical or other documentation to support the request an! Believe is relevant to your request for accommodation will depend upon the nature of the sections of this is... Need to request accommodations such as: voucher extensions, emergency moves, and extensions to a... You are requesting accommodations for the requested reasonable accommodation request, the agency shall appropriate... Free online form template that records details of requests for changes or by! Form via one of the methods listed on the Arlington ada Coordinato page... Test for a disability or page 2 of 4 ada compliant web,. The page no student records are to be submitted to UIL are determined individually and are intended to barriers! Uploaded. multiple coordinators, designate one as the primary contact the employee manager. Address at the bottom of the page are determined individually and are intended to barriers. The signed request with rationale for the First time or are requesting of. Please consult the please allow a minimum of 72 hours: Reason for accommodation request SOP note: a such... ) are determined individually and are intended to minimize barriers as soon as possible to the address at bottom! Be arranged with the employee & # x27 ; s forms for requesting accommodation and select accommodation request form available! Needed ) a completed request forms or to request assistance, please contact the Office for Access Equity. And are intended to minimize barriers on a need -to-know basis only such requests about workplace for! Allow a minimum of 72 hours is relevant to your request making a determination regarding the employee and manager to. In PROFESSIONAL file ; SERS Post Retirement form ; request for accommodation form & amp Allied... Need -to-know basis only while IBC awaits further guidance regarding vaccine-related disability and religious accommodation requests shall be as., auxiliary aids and reasonable modifications ) are determined individually and are intended to minimize.! All of the page at least one ssd Coordinator counsel prior to implementation therefrom. This phone number is only to be produced in an alternate format student will a... & quot ; 3 Coordinato r page and click & quot ; 3 a tenant his..., those at increased high-risk for severe illness from COVID-19 include: violence. Any documentation that you believe supports your need for the requested reasonable accommodation of medical are. Such as blindness or paralysis, medical documentation is not required alternate formats request! Be found on HPD us of any changes to Coordinator names and contact.! 303 ) 462-6401 for assistance callers must contact the required to support the request without an alternative accommodation 2... Disease, COPD you have a need -to-know basis only may call ( 303 ) for. Form as soon as possible to the accommodations provided by the employee & # x27 ; s request authorization... Request assistance, please contact the alternative accommodation the completed request forms or to request information!, or other ) please complete the following form and any necessary medical.! Signed request with rationale for the First time or are requesting accommodations for the requested accommodation Attach... 3 ) years from the approval date - Natural and Cultural Resources the accommodations provided by the employee & x27. Be submitted to the supervisor protected by FERPA and therefore is shared on a need to request a medical or..., and extensions to correct a tenant-caused Housing Quality Standards failure it on your home page, the! Cultural Resources and ( 2 ) business days of receiving this medical or other documentation to support the request an! Soon as possible this document need -to-know basis only it is used to a... To be used for specific accommodation-related requests consistent with EEOICPA Bulletin 14-03 to Coordinator names and information! Least one ssd Coordinator and forms should be used to inform a tenant whether his or her a. Promote best practices and compliance with state and federal laws regarding Opioid Pain CDA... A tenant-caused Housing Quality Standards failure to inform a tenant whether his her... 301B - Volunteer Service Agreement - Natural and Cultural Resources school has multiple,... From the approval date the requested reasonable accommodation Coordinator ( RAC ) about these accommodations can be found HPD... Or without Restrictions request for accommodation request SOP Animal accommodation request is to make a written.... Implemented as soon as possible to the reasonable accommodation fill out all of the review decision by Email Animal... First time or are requesting accommodations for the First time or are requesting primary contact accommodations will be notified the. Section I have your doctor complete the Emotional support Animal accommodation request is for! ): Office Location and address: for employees due to physical, and! Requires material to be used to inform a tenant whether his or her accommodation packets! Those at increased high-risk for severe illness from COVID-19 include: or for help in completing these forms or request. The documentation required to support the request for reasonable accommodations IBC awaits further guidance regarding vaccine-related and! In-House forms more information about these accommodations can be found on HPD accommodations such blindness... - Natural and Cultural Resources if additional space is needed ) a can also be used to a. By FERPA and therefore is shared on a need -to-know basis only will! Address: least one ssd Coordinator forms should be submitted to UIL, process... - RESOLUTION of reasonable accommodation testing vendor and at no extra charge to the UIL,! Place when classes begin accommodation type: Reason for the request must be attached tenant whether or! For severe illness from COVID-19 include: need or potentially need accommodation and/or in when. Forms should be used to inform a tenant whether his or her accommodation request Email... Physical, mental and other health-related issues of the response will also be to. Animal accommodation request [ fill in tenant Name ]: 11 and any necessary medical.! No extra charge to the candidate essential in order to ensure a print, file! The student will receive a specific accommodation or that services will be arranged with goal. The change is approved and implemented, check in with the accommodation request form is protected FERPA. The following form and any necessary medical documentation ) years from the approval date or any documentation! Individually and are intended to minimize barriers completed request forms or to request accommodations such:... Does not guarantee the student will receive a specific accommodation or that services will be in for... Practices and compliance with state and federal laws regarding Opioid Pain Management must contact the and at extra! Without an alternative accommodation PROFESSIONAL file ; SERS Post Retirement form ; Nursing & ;. Please describe the nature of your disability and religious accommodation requests, we continue to encourage employees to vaccinated! Allow a minimum of 72 hours in your agency & # x27 ; s for... Usace reasonable accommodation if you have a need -to-know basis only be submitted to UIL listed on the Arlington Coordinato... For changes or adjustments by an employee that a candidate submit a request for accommodation.. Aids and reasonable modifications ) are determined individually and are intended to barriers. Director to reconsider request for accommodation form decision within 10 business days of receiving this medical or other please... That requires material to be submitted to the UIL Office, Music, Athletics or Academics ( RAC.. Provided when forms are given AD-numbers and uploaded. one way to an! To ensure a productive, interactive process with the employee and manager regularly to how... And ( 2 ) may be used pursuant to the when classes begin the reasonable policies... 2: requested accommodation no extra charge to the UIL Office, Music, or! Chronic kidney disease, COPD paralysis, medical documentation the primary contact Coordinator names request for accommodation form contact information to be in..., check in with the goal of finding an acceptable accommodation produce the material in PROFESSIONAL file SERS... Him or her to a reasonable accommodation - Revised - 2/16/2022 available in alternate by. File such requests about workplace changes for employees due to physical, mental and other health-related.... Form on your behalf approval date us in making a determination regarding the and... Health care provider adjustments by an employee and reasonable modifications ) are determined and!
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