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Sample Accommodation Letter

This document provides an example of what to include in an accommodation request letter to an employer. The summary includes identifying yourself as a person with a disability, stating you are requesting accommodations under the ADA, identifying problematic job tasks and potential accommodation ideas, requesting employer accommodation ideas, and asking for a timely response. Medical documentation may also be attached to establish you have a disability requiring accommodation.

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4K views1 page

Sample Accommodation Letter

This document provides an example of what to include in an accommodation request letter to an employer. The summary includes identifying yourself as a person with a disability, stating you are requesting accommodations under the ADA, identifying problematic job tasks and potential accommodation ideas, requesting employer accommodation ideas, and asking for a timely response. Medical documentation may also be attached to establish you have a disability requiring accommodation.

Uploaded by

api-523392209
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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The following sample letter was taken from the Job Accommodation Network at:

https://askjan.org/media/accommrequestltr.cfm. It is meant to be an example but cannot


guarantee accommodations will be provided by the employer.

Sample Accommodation Request Letter


The following is an example of what can be included in an accommodation request
letter and is not intended to be legal advice.

Date of Letter
Your name
Your address
Employer's name
Employer's address
Dear (e.g., Supervisor, Manager, Human Resources, Personnel):
Content to consider in body of 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
 Request your employer's accommodation ideas
 Refer to attached medical documentation if appropriate*
 Ask that your employer respond to your request in a reasonable amount of
time

Sincerely, Your signature


Your printed name
Cc: to appropriate individuals

You may want to attach medical information to your letter to help establish that
you are a person with a disability and to document the need for accommodation.

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