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, I need (5) __________________________________.
According to the ADA and the federal Equal Employment Opportunity Commission (EEOC), removing physical access barriers is a form of reasonable accommodation. See 42 U.S.C. § 12111(9)(A) and the section entitled “General Principles” and Question 46 in EEOC Enforcement Guidance on Reasonable Accommodation and Undue Hardship Under the Americans with Disabilities Act, both 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) Describe the change you are seeking and how it relates to your disability. Examples:
“It is difficult for me to navigate my wheelchair in my assigned cubicle. I am requesting to be moved into a larger cubicle with an accessible desk.”
“The bathroom is not accessible for me and my scooter. I am requesting that the company combine two stalls into one larger stall.”
“My disability affects my ability to concentrate. I am requesting a quieter work station with fewer distractions. I could move to one of the cubicles in the corner, or a partition could be added to my current cubicle.”
“I use a lift-equipped van, and need an accessible parking spot near the entrance.”
Last updated: October 2024