DMHAS Reasonable Accommodation Request Form 2026

1. Click ‘Get Form’ to open the Reasonable Accommodation Request Form in our editor.
2. Begin by selecting either Box 1 for DMHAS employees or Box 2 for applicants. Fill in the required fields such as Date, Name, and Position Title for Box 1, or Position Applied For and Applicant Name for Box 2.
3. In Section A, provide a detailed description of your physical or mental impairment. Be specific about how it limits major life activities. You can attach additional pages if necessary.
4. For employees only, complete Section B by explaining how your impairment affects your ability to perform essential job functions.
5. In Section C, describe the accommodation you are requesting clearly and concisely.
6. Finally, fill out your contact information including mailing address and phone number before submitting the form to the facility EEO specialist.

Start filling out your form online today for free with our platform!