Office of Equal Opportunity Division of Institutional Diversity Oklahoma State University 408 Whitehurst Stillwater OK 74078 Phone 405.744.9153 Fax 405.744.5576 Rosalyn.green – – – – EMPLOYMENT ACCOMODATION REQUEST FORM Employee Name: Employee Employee CWID: Employee Email Address: Department: Date Requested: Supervisor: Supervisor This form is the initial step in processing your request for a reasonable accommodation the University’s procedure. An accommodation is a reasonable modification or adjustment to the work environment that enables a qualified individual with a disability to perform the essential functions of a position, and enjoy the same benefits and privileges of employment as enjoyed by non-disabled employees. In order to determine whether you are eligible for an accommodation under the ADA (1990), as amended by ADA Amendment Act of 2008 (ADAAA), the Office of Equal Opportunity may request that you provide documentation of your medical condition. Having a medical condition alone is not enough to make you eligible for an accommodation under the ADAAA guidelines. Under the ADAAA, an individual with a disability is a person with a physical or mental impairment that substantially limits one or more major life activities; has a record of such impairment; or is regarded as having such impairment. A substantial limitation is defined as an impairment that prevents the performance of a major life activity that most people in the general population can perform. The ADAAA requires that the University keep medical information confidential. However, the law allows certain individuals to be informed of your condition as needed. These persons can include your manager(s) or supervisor(s), human resources personnel, first aid and safety personnel, personnel investigating compliance discussing your condition or medical information about yourself.
Office of Equal Opportunity Division of Institutional Diversity Oklahoma State University 408 Whitehurst – Stillwater OK 74078 – Phone 405.744.9153 – Fax 405.744.5576 – Rosalyn.green EMPLOYMENT ACCOMODATION REQUEST FORM Employee Name: Employee Employee CWID: Employee Email Address: Department: Date Requested: Supervisor: Supervisor This form is the initial step in processing your request for a reasonable accommodation the University’s procedure. An accommodation is a reasonable modification or adjustment to the work environment that enables a qualified individual with a disability to perform the essential functions of a position, and enjoy the same benefits and privileges of employment as enjoyed by non-disabled employees. In order to determine whether you are eligible for an accommodation under the ADA (1990), as amended by ADA Amendment Act of 2008 (ADAAA), the Office of Equal Opportunity may request that you provide documentation of your medical condition. Having a medical condition alone is not enough to make you eligible for an accommodation under the ADAAA guidelines. Under the ADAAA, an individual with a disability is a person with a physical or mental impairment that substantially limits one or more major life activities; has a record of such impairment; or is regarded as having such impairment. A substantial limitation is defined as an impairment that prevents the performance of a major life activity that most people in the general population can perform. The ADAAA requires that the University keep medical information confidential. However, the law allows certain individuals to be informed of your condition as needed. These persons can include your manager(s) or supervisor(s), human resources personnel, first aid and safety personnel, personnel investigating compliance discussing your condition or medical information about yourself.