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ADA Request Form

Please complete the form below. Required fields marked with an asterisk *
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IMPORTANT ADDITIONAL INFORMATION

Employees must send the Office of Human Resources a letter from their medical provider containing the following information: 

  1. The medical conditions(s) of the employee in reference to their request for accommodations based on the ADA (Americans with Disabilities Act). 

  2. How the disability limits the employees performance of essential functions of the position. 

  3.  Identify possible accommodations that may enable the employee to perform the essential job functions.

  4. How will the medical provider's  suggestions will improve the employee’s ability to perform the essential job functions? 

  5. How long do the medical provider expect this accommodation to be necessary? 

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