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ADA Reasonable Accommodation Request
Written request for reasonable accommodation under the Americans with Disabilities Act from an employer, business, or public entity.
PDF TemplateUse the instructions below to complete this form
Instructions
You do not need to use specific legal language or mention the ADA. Describe your disability and how it limits your ability to perform job functions or access services. Propose specific accommodations that would enable you to perform essential functions. Include supporting medical documentation if requested by the employer. The employer must engage in an interactive process to identify effective accommodations. Employers may deny requests that impose an undue hardship.