• Image-33
  • Human Resources
    111 University Parkway, Suite 100
    Yakima WA 98901
    Phone: 509-452-5100
    Fax: 509-452-5101

  • Employee Reasonable Accommodation Request Form

  • Human Resources is the point of contact for employees who need to discuss accommodation for a disability.  Employees who have a disability may be entitled to a reasonable accommodation under state or federal law.  Individuals requesting a reasonable accommodation for a disability are encouraged to provide as much information as possible so that Pacific Northwest University (PNWU) can evaluate the request and provide reasonable appropriate aids, services or other reasonable accommodations.  We ask that you (or another person on your behalf) complete this form, or provide the requested information in a different format, and provide that information along with supporting documentation to hr@pnwu.edu.  Additional information may be requested after PNWU's evaluation.

    All information shared with the University through the evaluation and/or reasonable accommodation process will be treated as confidential and maintained in accordance with legal requirements.

  •  -
  • REASONS FOR REQUESTING ACCOMMODATIONS

    Please respond to the following questions regarding the diagnosis(es) for which you are requesting accommodations.

  • Upload a File
    Cancelof
  • I acknowledge that by pressing the submit button, I am officially signing this document. My typed name below is my symbol and intent of authentication where I willingly signed, understand, and adopt this document.

  • Should be Empty: