Disability Accommodation Request for Applicants
Georgetown University is committed to the full inclusion of all individuals and to the principle of individual rights and responsibilities. Our accommodation procedures will ensure that persons with a disability will not be, denied full and equal access to programs and services or otherwise be subjected to discrimination under programs or activities offered by the University, on the basis of that disability.

An applicant in need of an accommodation is encouraged to complete this form in its entirety and describe the disability and specify the accommodation needed. All requests are handled on a case-by-case basis. This form and any supplemental documentation provided will be kept confidential and will not be shared with the employing unit or retained in the permanent employee personnel file should the applicant be selected. The purpose of this form is to assist the University in determining whether or to what extent a reasonable accommodation is required for an applicant to participate in the hiring process.
Sign in to Google to save your progress. Learn more
Email *
Name *
Position Sought
Department
Date of Interview
MM
/
DD
/
YYYY
What is your accommodation request? *
Explain how the requested accommodation would assist you in participating in the job application/selection process.
If this request is time sensitive, please explain.
Is there any other information that would help us evaluate your request?
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Georgetown University. Report Abuse