Workplace Accommodation Request

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Workplace Accommodation Request

Accommodations are for employees who desire to work, or the district has work to perform, but are requesting a reasonable accommodation in order to complete the assigned duties outlined in their job description. The District will review and determine if the accommodation request is reasonable. The District may request medical documentation from a medical provider.

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* Indicates required question

Email *

Your email

Employee First Name *

Your answer

Employee Last Name *

Your answer

Job Title *

Your answer

Location *

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Please list the workplace accommodation(s) requested and rationale: *

Your answer

Dates Accommodations Requested

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