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Sample Accommodation Request 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.
Because of my disability, I need the following accommodations: [LIST ACCOMMODATIONS]. A medical provider has prescribed this accommodation for my disability. I would like to meet with you to discuss these and any other accommodations that will enable me to have an equal opportunity to live in and enjoy this residence.
[Employer] is committed to providing access, equal opportunity and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. To request reasonable accommodation, contact [include name and/or department, telephone, and e-mail address].
The easiest way to handle this process is to be honest and direct with your employer. Schedule a time to sit down with them one-on-one and explain to them how you were diagnosed and the details of what you are struggling with.
Your doctor will want you to sign a consent form, allowing the doctor to provide details about your medical condition that would otherwise have to be kept confidential. Once youve given your consent, the doctor should write a brief letter explaining your condition and suggesting possible accommodations.
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A reasonable accommodation letter from a doctor is a document that a person with a disability can provide to their employer in order to request an accommodation that will allow them to perform their job duties.
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.
Accommodation Request or Request means a request for Auxiliary Aids and Services and/or for modifications to policies, practices, and procedures to accommodate the needs of Customers with vision or hearing impairments.

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