Employee ADA Accommodation Request

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Employee Information

Please enter your information

First Name

Last Name

Middle Name

Pronouns

Employee ID

Please use your university issued email address

Phone Number

Department

Job Title

Supervisor

Supervisor's Email Address

Supervisor's Phone Number

Office Location

At which location are you primarily located?

Accommodation Request Details

Is this request related to Covid-19?

Is this a request for temporary accommodations?

Please describe the condition for which you are requesting an accommodation

Please explain how the condition affects your ability to perform your job

Please provide a detailed description of the reasonable accommodation you are requesting

Employee Signature

Upload supporting document(s)

Your confidential request and medical documentation will be submitted directly to the Office for Campus Accessibility. Your supervisor/department chair/dean’s office should never request medical documentation from you. The medical documentation is typically in the form of a letter from your doctor or other medical provider (signed/dated/on letterhead) which confirms your medical condition/symptoms, gives their anticipated duration (if known), and describes the functional limitations imposed by the condition that could affect your work.

If your provider is comfortable recommending accommodations that could help you at work, please ask them to include that information in the letter. You can upload the letter below, or your doctor can email the Office for Campus Accessibility directly at ADAaccess@tulane.edu. The Office for Campus Accessibility will keep any medical documentation you submit in a confidential file, separate from your general HR personnel file.

Employee ADA Accommodation Request

Employee Information

Accommodation Request Details

Document Information