Accommodation Request Form

To Employee:  Please complete this form to the best of your ability. It will be sent to the Human Resources Department upon submission.  This form is to initiate the process of investigating and evaluating your request for accommodation.  You will have the opportunity to submit additional information about your accommodation request. 

Requestor's name(Required)
Supervisor's Name(Required)

Please contact Human Resources if you prefer to use a paper form instead of the online form.