California request reasonable accommodation form 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by indicating whether your original request was verbal or written by checking the appropriate box.
3. Fill in the date of your original request and, if applicable, the date you completed this form.
4. Provide your personal information, including your name as the head of household, address, cell phone number, home telephone number, and email address.
5. Indicate if you are attaching medical documentation. Remember, it's not mandatory to attach it at this stage.
6. Select the reasonable accommodation(s) you are requesting by checking the relevant boxes. If needed, specify any additional accommodations in the provided space.
7. List the name and contact details of a healthcare provider who can verify your disability and need for accommodation.
8. Sign and date the form before submitting it to ensure all information is accurate and complete.

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