Reasonable Accommodations Modification Request Form 2025

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  1. Click ‘Get Form’ to open the Reasonable Accommodations Modification Request Form in our editor.
  2. Begin by filling out your personal information, including your name, phone number, physical address, email address, and city/state/zip code. This ensures that the request is properly attributed to you.
  3. In the first section, describe the specific accommodation or modification you are requesting. Be clear and concise about how this change will help you or someone associated with you.
  4. Next, explain the relationship between the disability and the need for your requested accommodation/modification. Remember to keep this section focused on how it relates to your request without disclosing detailed medical information.
  5. Indicate whether the person requiring assistance is yourself or someone living with you by checking the appropriate box and providing their name if applicable.
  6. Finally, sign and date the form at the bottom to confirm your understanding of the verification process outlined in the Fair Housing Act.

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Dear [Insert employers name here]: I have been having medical issues that have affected my mood, sleep schedule, concentration, and focus. I would like to request accommodations so that I might be able to perform my job effectively before my performance starts to suffer.
Examples of reasonable modifications may include installing ramps, widening doorways, lowering kitchen counters, or modifying bathrooms for wheelchair accessibility. The FHA requires that housing providers permit disabled tenants to make reasonable modifications, at the tenants cost.
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
I am experiencing the following difficulties in performing my job because of my disability: . I am writing to request that you (state requested accommodation) because it will (how it will help you do your job) as a reasonable accommodation.
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)
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For example, maybe the employer needs more information about your disability and how your limitations or restrictions affect your ability to perform the essential duties of the job. Or perhaps the accommodation you requested isnt reasonable or will cause an undue hardship for the employer.

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