Request for Reasonable Accommodation

Employee Information

Please include your name and UK ID number as well as your immediate supervisors name and contact information.

Name

Select Role

ID Number

Phone number

Email address

Questions

Please provide your job title and department.(Required) This field is required.

Identify your disability or physical or mental impairment(s) or limitation(s):(Required) This field is required.

Explain how your disability impairs or limits your ability to perform assigned job duties:(Required) This field is required.

Expected duration of the disability:(Required) This field is required.

What specific accommodation(s) are you requesting?(Required) This field is required.

Have you had any accommodations in the past for this same limitation? If yes, what were they and how did the accommodation(s) help you perform your job?(Required) This field is required.

Please provide any additional information that might be useful in processing your accommodation request.(Required) This field is required.

Supporting Documention

Once this request is submitted, you will receive more information about how to provide additional information through the medical inquiry form. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Employee Information

Questions

Supporting Documention

Submission