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Workplace Accommodation Request Tool

Use this tool to create a letter to request a workplace accommodation. If you haven't already, read Asking for an Accommodation at Work for more information about using this tool to request a workplace accommodation.

To create your letter, follow these steps:

  1. Complete the form below
  2. Click the "Submit" button
  3. You will be taken to a new page that has a PDF of your letter
  4. Download or print the PDF of your letter
  5. Submit your letter to the employer via email, mail, or in-person

Please note: this tool will not submit the letter to the employer. You must download or print the letter and submit it to the employer.

Languages: this Workplace Accommodation Request Tool is available in English and Spanish. Be aware that DRTx recommends that you provide your request in a language understandable to the party or entity receiving it, which in most circumstances will be English.

Form

"*" indicates required fields

Your Name * Required
Enter your first and last name.
Job Status * Required
Are you seeking an accommodation for a job you already have, or for a new job that you have not yet started?
Enter the name of the company or organization you work for.
Enter your job title.
Enter the name of the company or organization you want to work for.
Enter the title of the job you are trying to get.
Enter the name of the disability or condition that is the reason for your accommodation request.
Accommodation Request * Required
What accommodation(s) are you asking for? You can select more than one, but only select the accommodation(s) that you think will help you personally.
Period of Leave * Required
If you are requesting a reasonable period of leave, do you know the date when you expect to return to work? If you do not know the date that you will return to work, that's okay - you can still request a reasonable period of leave. But you should get your expected return-to-work date to the employer in writing as soon as possible.
Return to Work Date * Required
If you are requesting a reasonable period of leave, what is your expected return-to-work date?
What new work schedule are you asking for?
Full-Time to Part-Time? * Required
Is the change in schedule you are asking for a change from full-time to part-time?
Return to Full-Time Date
Normally, an employer does not have to permanently change a full-time job to a part-time one. So if you are asking for a schedule change from full-time to part-time, you should tell your employer when you will be able to go back to full-time. What is the date that you expect to return to full-time?
Telework or Work Remotely
Teleworking, or working remotely, means working from home or from some location other than the regular work location. Some jobs cannot be done remotely, but some can. Some people request to telework full-time, while others ask to work remotely part of the time and to work at the regular work location the rest of the time. Are you asking to telework/work remotely full-time or part of the time?
If you are asking to telework/work remotely only part of the time, you should explain the schedule you are asking for. What days and times are you asking to work remotely?
Temporary Requests
When requesting to telework/work remotely, a request that is for a temporary period of time may be more likely to be granted, depending on the job and the employer. Is your request for a temporary period of time?
What physical barriers are you asking be removed?
What changes to your computer or your computer system are you seeking? This could include software, hardware, or other devices.
What tools, equipment, training, or other things are you asking for?
What situation(s) are you asking for a sign language interpreter for? Cost can be a factor, so it can help to be specific about the situation(s) you need an interpreter for.
Reassign Me to a Different Job * Required
Your accommodation request can be to be reassigned to another job at the same company or organization. Normally, the employer only has to reassign you to another position if it is vacant (or soon to be vacant), is not a promotion, and is a job that you are able to do. Do you know the name of the job you want to be reassigned to? If you don't know the name of the job, that's okay - you can still submit your request for an accommodation.
If you are requesting to be reassigned to a different job at the company or organization, what is the name of the job?
Think about whether the task or duty you want to avoid is important for your particular job. The employer normally does not have to permanently eliminate tasks or job duties if they are essential for the job. What task or job duty are you requesting to stop doing?
If the sample accommodations listed above are not relevant to your situation, what accommodation are you requesting?
Your Contact Information * Required
How would you like to be contacted by the company? Email and phone may help you get a response faster, but you could also choose to receive the response via regular mail.
Your Mailing Address * Required
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