Religious Accommodation Form

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Georgetown University maintains a Policy on Non-Discrimination on the Basis of Religion and National Origin. As set forth in that policy, the University is sensitive to the diverse religious practices and observances of its current and prospective employees. It is the University’s practice to provide a consistent and methodical approach in addressing requests for reasonable accommodations based on sincerely held religious beliefs.

The purpose of this form is to assist the University in determining whether, or to what extent, a religious accommodation can be granted

Email *

Name *

Phone Number *

Position

Department

Supervisor's Name *

Supervisor's Title *

Supervisor's Email
*

Employee Status

Staff

Faculty

Student Employee

Union Employee

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Are you requesting exemption from the University's COVID-19 vaccination and/or booster requirement? *

Yes

Required

Identify the specific accommodation you are requesting (e.g. time to pray during work hours, use of paid/unpaid leave for a religious observance, religious garb, etc.).

Identify the reason you are requesting the accommodation (e.g. what is the sincerely held religious belief or practice for which you are seeking accommodation?).

State the date(s) and frequency of the requested accommodation (e.g. daily or weekly?).

A copy of your responses will be emailed to the address you provided.

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