MEMORANDUM
TO: (1) ____________________________
FROM: (2) ____________________________
RE: Request for Reasonable Accommodation
DATE: (3) ________________________
This is a request for reasonable accommodation under the Americans with Disabilities Act (ADA) and the California Fair Employment and Housing Act (FEHA). If you are not the appropriate person to receive this request, please notify me immediately, and forward this letter on to the person who handles requests for reasonable accommodation.
I am a person with a “disability” under state and federal laws. [My condition is (4) _________________.] As a result of my disability, (5) _________________________________________.
According to the federal Equal Employment Opportunity Commission (EEOC), adjusting supervisory methods is a form of reasonable accommodation. See Question 33 in EEOC Enforcement Guidance on Reasonable Accommodation and Undue Hardship Under the Americans with Disabilities Act, available at www.eeoc.gov.
Please let me know if you require reasonable medical documentation of my condition, or if you wish to propose alternative accommodations to those I have requested. I am ready and willing to engage in the interactive process with you so that I may continue in my employment.
Thank you.
(1) Name of Human Resources director, supervisor, program director, or another manager
(2) Your name
(3) Today’s date
(4) Optional: State the name or a description of your condition using language you feel comfortable with.
(5) Explain why you need an adjustment to supervisory methods because of your disability. Examples:
“I have difficulty with organization and time management due to my ADHD. I would like to meet with my supervisor once a month to review assigned tasks and deadlines.”
“Because of my intellectual disability, I need to have my job broken up into smaller tasks. I would like my supervisor to work with me and my job coach to develop a checklist for each of my work stations.”
“I have trouble following oral directions due to a learning disability. I am requesting that my supervisor follow up meetings with an email summarizing instructions.”
“I am experiencing anxiety during interactions with my supervisor because she speaks quickly and sometimes raises her voice in front of my coworkers. I am requesting that my supervisor hold counseling sessions in her office, and that she slow down so that I can take notes.”