Disability accommodation request form sample
[DOCX File]REQUEST FOR A REASONABLE …
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(Date) Mr./Mrs. (Name of Housing Manager) (Job Title of Housing Manager) (Address) Dear : I am a tenant in apartment number. I am a person with a disability as that term is defined under the “Americans with Disabilities Act,” the “Fair Housing Act,” and the “Maine Human Rights Act.”
[DOC File]1 -- Sample Request for RA -- Equipment (00286132).DOC
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This is a request for reasonable accommodation under the Americans with Disabilities Act (ADA) and the California Fair Employment and Housing Act (FEHA). If you are not the appropriate person to receive this request, please notify me immediately, and forward this letter on to the person who handles requests for reasonable accommodation.
[DOCX File]Agency Logo - Oregon
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Completing this form is helpful, but employees are not required to complete it in order to request an accommodation under the ADA. Employees who wish to verbally request an accommodation or if they need help completing this form may contact (insert name), ADA Coordinator at (insert email address), (503) 000-0000, TTY users call (503) 000-0000
[DOC File]Reasonable Accommodation Agreement - sample letter
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The accommodation [will begin or began] on [date] and end based upon future doctor visits. The description of the [modified/alternate] employment is as follows (include description of accommodation here): This is a temporary accommodation, not. a permanent position. It was created to assist you while you are recovering.
SAMPLE REASONABLE ACCOMMODATION REQUEST FORM …
Sample Reasonable Accommodation Form . for Employers. Sample Reasonable Accommodation Request Form for Employers. The Americans with Disabilities Act of 1990 (ADA) requires employers to provide reasonable accommodations for qualified employees with disabilities, unless such accommodations pose an undue hardship (e.g., too costly, too extensive, too substantial, too disruptive).
[DOC File]Sample of Letter to Request Reasonable Accommodation
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Under the Fair Housing Amendments Act, it is unlawful discrimination to deny a person with a disability a reasonable accommodation of an existing building rule or policy if such accommodation may be necessary to afford such person full enjoyment of the premises. Please keep this request for accommodation confidential, as required by federal law.
Sample: Certification of Need for Reasonable Accommodation ...
SAMPLE: CERTIFICATION OF NEED FOR REASONABLE ACCOMMODATION REQUIRING CHANGES TO POLICIES, PROCEDURES OR PRACTICES OF THE HOUSING DEVELOPMENT (Necessary ONLY if disability and or/need for accommodation is not obvious or known to housing provider) Note to housing provider: Use similar language for a 5 year consent release.
[DOCX File]Disability Inclusion: Reasonable Accommodation (RA) Guidance
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Accommodation Request form can be found at https://AskJAN.org/Forms/upload/raform.doc If the disability or need for accommodation is obvious or adequate medical documentation has already been provided for other reasons (i.e. Family Medical Leave Act, Workers Compensation), no medical documentation will be required.
[DOCX File]ADA aCCOMMODATION MEDICAL CERTIFICATION fORM
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During the interactive process, if appropriate, an employer may request medical documentation in support of an employee’s disability, any restrictions or barriers the employee may experience as a result of the disability, and any suggestions for potentially effective accommodations. This documentation must be provided by the employee.
Sample: Reasonable Accommodation Policy
Applicants or residents may make Reasonable Accommodation requests at any time and may make them verbally although for reasons of clarity for both parties, [name of development] recommends filling out a written Reasonable Accommodation Request Form for all but routine requests. The forms may be obtained from [position, office, etc].
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