Reasonable Accomodation Request Form (Illinois - State of Illinois - www2 illinois 2025

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The document outlines the process for requesting reasonable accommodations for AmeriCorps members with disabilities in Illinois. It defines 'disability' and 'reasonable accommodation,' provides a form for members to specify their needs, and emphasizes confidentiality and compliance with laws. The form requires details about the member's disability, job functions affected, and the type of accommodation requested. It also includes sections for supervisor recommendations and final decisions by the Illinois Commission on Volunteerism and Community Service.
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[Employer] is prepared to modify or adjust the job application process or the job or work environment to make reasonable accommodations to the known physical or mental limitations of the applicant or employee to enable the applicant or employee to be considered for the position he or she desires, to perform the
Reasonable Accommodation is modifications or adjustments to the job application process and the work environment that enable qualified applicants or employees with disabilities to be considered for a position, to perform the essential functions of a position in the manner or circumstances under which the position held
What to Include in Your Reasonable Accommodation Letter Your name and position. The date. Information about your disability. A request for accommodation. Accommodation ideas. Medical information.
Sufficient medical documentation should describe the nature, severity, and duration of the impairment, the activity or activities that the impairment limits, the extent to which the impairment limits the employees ability to perform the activity or activities, and should also substantiate why the requested reasonable
The duty to engage in the interactive accommodation process under title I of the Americans with Disabilities Act (ADA) is triggered when a request for reasonable accommodation is received, or when an employer has a reasonable belief that an employee may need accommodation due to a known disability that is affecting job

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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.
An individual meets the Americans with Disabilities with Act definition act of disability that would qualify them for reasonable accommodations if they have a physical or mental impairment that substantially limits one or more major life activities (sometimes referred to in the regulations as an actual disability)
In your reasonable accommodation letter, you should provide all the information your employer will need to begin the accommodation process, including what your disability is, how it affects you, which aspects of your job might require modification, and proposed accommodations.

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This form is for System Office employees only. To complete the reasonable accommodation request form paperless and online, please use the following link.

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The procedures for accommodation request appear on the back of this form. Completed accommodation request forms should be submitted to the interviewing officer.

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a link to the PA request form, is available in the Medical Management Program section of this Provider Manual. Family planning services related to the

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