Fair Accommodation Request Form
Please complete this form to request a fair accommodation. Your information will be reviewed to determine eligibility and next steps.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Department or Organization (if applicable)
Type of Accommodation Requested
*
Please Select
Physical access
Schedule adjustment
Remote participation
Communication support
Other
Please describe the accommodation you are requesting
*
Reason or context for your request (do not include sensitive health or ID information)
*
Preferred method of contact
Email
Phone
Upload supporting documentation (optional, do not upload sensitive medical or ID documents)
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