Current Start Preview Submission Complete Full assistance shall be provided to any applicant/employee seeking to utilize this formal process of request for reasonable accommodation. The individual requesting shall have the opportunity for a thorough discussion with Katie Temple, Senior Benefits Generalist, when these forms are provided. This form may be used by any employee seeking accommodation, by any applicant or employment seeking accommodation during the application/selection process, and by any other person seeking, other than students, accommodation in conjunction with his or her participation in any of UMass programs, services or activities, including employment. The purpose of providing reasonable accommodation is to enable a person with a disability to perform the essential functions of the job. Therefore, information is necessary to determine: Whether the requestor actually requires a reasonable accommodation, and The nature and extent of the accommodation, if one is required. This information will be used only for the purpose of taking voluntary action to overcome the effects of conditions limiting opportunities for persons with disabilities. Although the information is being requested on a VOLUNTARY basis and will be kept CONFIDENTIAL, your failure to provide us with sufficient information necessary for us to make a reasonable accommodation determination may result in a decision that does not adequately address your needs. Name First Last Department - Select -Academic and Workforce AffairsBudget OfficeCommunicationsControllerEconomic DevelopmentFacilities and OperationsGeneral CounselGovernment AffairsHuman ResourcesInformation Technology ServicesInternal AuditTreasurerUnified Procurement Services Team Questions to clarify accommodation request. What specific accommodation are you requesting? If you are not sure what accommodation is needed, do you have any suggestions about what options we can explore? - None -YesNo Please provide your suggestions below. Is your accommodation request time sensitive? - None -YesNo Please provide more information around the time sensitivity of your request. Questions to document the reason for accommodation request. What, if any, job function are you having difficulty performing? What limitation is interfering with your ability to perform your job or access any employment benefit? Have you had any accommodations in the past for this same limitation? - None -YesNo Please provide details regarding past accommodations. Preview Submit Leave this field blank