REASONABLE RELIGIOUS ACCOMMODATION REQUEST FORM

Fields marked with * are required.

Your Name: *
Enter your name. Required.
Title/Position: *

Department: *

Work Phone Number:
Home/Cell Phone Number:
Please specify the religious belief/practice you have for which you are requesting accommodation.

What reasonable accommodation are you requesting at this time? What are some accommodation options?

The Office of Equal Opportunity, Diversity & Outreach will review your request, and you will be contacted to discuss your requested accommodation. This information will be maintained confidentially to the extent practicable under the circumstances.

The above information is complete and accurate to the best of my knowledge and belief.

Your email address: *
Enter your email address. Required.