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Accommodation Request Medical Inquiry 2018-2025 Form
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People also ask
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How do I write a letter asking for accommodation?
I am experiencing the following difficulties in performing my job because of my disability: _______________________. I am writing to request that you ______________________ (state requested accommodation) because it will___________________________ (how it will help you do your job) as a reasonable accommodation.
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What is an accommodation assessment form?
This form is commonly used to obtain information from a healthcare provider to substantiate that an employee has a medical impairment, associated limitations, and requires accommodation under the ADA.
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How do I write a letter of accommodation request?
Content to consider in body of letter: Identify yourself as a person with a disability. State that you are requesting accommodations under the ADA (or the Rehabilitation Act of 1973 if you are a federal employee) Identify your specific problematic job tasks. Identify your accommodation ideas.
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What is an example of an accommodation statement?
Sample Statements If you need disability-related accommodations, please call [insert telephone number of the sponsor]. Persons with disabilities who anticipate needing accommodations or who have questions about physical access may call [telephone number of the sponsor] in advance of the program [or film, event, etc.].
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What are some examples of reasonable accommodations?
Reasonable accommodation can include, but is not limited to, the following: Changing job duties. Providing leave for medical care. Changing work schedules. Relocating the work area. Providing mechanical or electrical aids.
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What is an example of a reasonable accommodation request letter?
Letter to Request a Reasonable Accommodation I am your tenant at [apartment address]. I am writing to request a reasonable accommodation pursuant to the Fair Housing Act so that I can equally enjoy and use my apartment. I am a person with a disability because [elements of impairment] affect my daily living activities.
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