Notes to letter writer:

1. Employees should send this letter to the right person, such as an immediate supervisor or ADA coordinator.
2. Employees are not required by law to make a reasonable accommodations request in writing.  Requests can be made orally.
3. When an employee requests a reasonable accommodation in writing, the employee should keep a copy.

_________________________________________________________________________________________

Employer’s Address

Date of Letter

Dear _________:

I work (or: I am applying) as a _______(fill in job) for _______(fill in company or department). I am writing to formally request a reasonable accommodation for my disability under ______ (choose one or both: “federal” and/or “state”) laws governing reasonable accommodations for persons with disabilities.  Although I am otherwise qualified for my position, I am limited in my ability to ______ (state type of task affected by disability, for example, “lift heavy objects”; “take the regularly scheduled bus”; “use an auditory telephone”; “type quickly”).  Therefore, I will need accommodations in order to ______ (state job task for which you need accommodation, for example “move the encyclopedias”; “arrive at work by 8am”; “answer telephone calls”; “type memos”).

From my experience, I know that _____ (state possible solution, for example, “obtaining a dolly”; “telecommuting from home”; “obtaining a TTY machine”; “being allotted more time for typed projects”) would be a sufficient accommodation.  However, I am open to other solutions that you may suggest.  I also would be willing to meet with you to discuss other options.

(Omit the following paragraph if the request you make costs nothing.)  As you probably know, you may be eligible for tax deductions or tax credits for expenses incurred in providing reasonable accommodations to persons with disabilities.  For more information about your eligibility for tax credits, you can contact the Mid-Atlantic ADA Center at 800-949-4232 or the Equal Employment Opportunity Commission at 800-669-4000.

If you would like medical verification of my disability, I can provide you with the appropriate documents upon your request. (Alternatively, “I have attached medical documentation verifying my disability.”)

Thank you for your attention to this matter.  I would appreciate a response to this letter within one week so that I can be as efficient in my job as possible.  I look forward to cooperating with you to find an effective and economical solution.

Thank you,

Employee’s Signed and Printed Name
Employee’s Mailing Address and Phone Number