Workplace Accommodation Request Tool

Use this tool to create a letter to request a workplace accommodation. If you haven't already, read Asking for an Accommodation at Work for more information about using this tool to request a workplace accommodation.

To create your letter, follow these steps:

Complete the form below
Click the "Submit" button
You will be taken to a new page that has a PDF of your letter
Download or print the PDF of your letter
Submit your letter to the employer via email, mail, or in-person

Please note: this tool will not submit the letter to the employer. You must download or print the letter and submit it to the employer.

Languages: this Workplace Accommodation Request Tool is available in English and Spanish. Be aware that DRTx recommends that you provide your request in a language understandable to the party or entity receiving it, which in most circumstances will be English.

Form

"*" indicates required fields

Your Name * Required

Enter your first and last name.

First Last

Job Status * Required

Are you seeking an accommodation for a job you already have, or for a new job that you have not yet started?

I have the job

This is a new job I have not yet started

Company Name * Required

Enter the name of the company or organization you work for.

Your Job Title * Required

Enter your job title.

Company Name * Required

Enter the name of the company or organization you want to work for.

Title of Job You Are Seeking * Required

Enter the title of the job you are trying to get.

Your Disability * Required

Enter the name of the disability or condition that is the reason for your accommodation request.

Accommodation Request * Required

What accommodation(s) are you asking for? You can select more than one, but only select the accommodation(s) that you think will help you personally.

A reasonable period of leave

A change in my schedule

Telework or work remotely

Remove physical barriers

Adapt my computer

Provide me with tools, equipment, or training

Arrange for a sign language interpreter

Reassign me to a different job

Stop doing a task or job duty

Other accommodation request

Period of Leave * Required

If you are requesting a reasonable period of leave, do you know the date when you expect to return to work? If you do not know the date that you will return to work, that's okay - you can still request a reasonable period of leave. But you should get your expected return-to-work date to the employer in writing as soon as possible.

Yes, I know my expected return-to-work date

No, I don't know my expected return-to-work date

Return to Work Date * Required

If you are requesting a reasonable period of leave, what is your expected return-to-work date?

Month

Day

Year

Change in Schedule * Required

What new work schedule are you asking for?

Full-Time to Part-Time? * Required

Is the change in schedule you are asking for a change from full-time to part-time?

Yes

Return to Full-Time Date

Normally, an employer does not have to permanently change a full-time job to a part-time one. So if you are asking for a schedule change from full-time to part-time, you should tell your employer when you will be able to go back to full-time. What is the date that you expect to return to full-time?

Month

Day

Year

Telework or Work Remotely

Teleworking, or working remotely, means working from home or from some location other than the regular work location. Some jobs cannot be done remotely, but some can. Some people request to telework full-time, while others ask to work remotely part of the time and to work at the regular work location the rest of the time. Are you asking to telework/work remotely full-time or part of the time?

Full-time

Part of the time

Telework/Remote Work Schedule

If you are asking to telework/work remotely only part of the time, you should explain the schedule you are asking for. What days and times are you asking to work remotely?

Temporary Requests

When requesting to telework/work remotely, a request that is for a temporary period of time may be more likely to be granted, depending on the job and the employer. Is your request for a temporary period of time?

Yes

Remove Physical Barriers * Required

What physical barriers are you asking be removed?

Adapt My Computer * Required

What changes to your computer or your computer system are you seeking? This could include software, hardware, or other devices.

Provide Me with Tools, Equipment, or Training * Required

What tools, equipment, training, or other things are you asking for?

Arrange for a Sign Language Interpreter * Required

What situation(s) are you asking for a sign language interpreter for? Cost can be a factor, so it can help to be specific about the situation(s) you need an interpreter for.

Reassign Me to a Different Job * Required

Your accommodation request can be to be reassigned to another job at the same company or organization. Normally, the employer only has to reassign you to another position if it is vacant (or soon to be vacant), is not a promotion, and is a job that you are able to do. Do you know the name of the job you want to be reassigned to? If you don't know the name of the job, that's okay - you can still submit your request for an accommodation.

Yes, I know the name of the job

No, I don't know the name of the job

Name of Different Job

If you are requesting to be reassigned to a different job at the company or organization, what is the name of the job?

Stop Doing a Certain Task or Job Duty * Required

Think about whether the task or duty you want to avoid is important for your particular job. The employer normally does not have to permanently eliminate tasks or job duties if they are essential for the job. What task or job duty are you requesting to stop doing?

Other Accommodation Request * Required

If the sample accommodations listed above are not relevant to your situation, what accommodation are you requesting?

Your Contact Information * Required

How would you like to be contacted by the company? Email and phone may help you get a response faster, but you could also choose to receive the response via regular mail.

Phone

Mail

Your Email Address * Required

Your Phone Number * Required

Your Mailing Address * Required

Street Address Address Line 2 City State ZIP Code

Disability Rights Texas logo

www.DRTx.org
Statewide Intake: 1-800-252-9108
Sign Language Video Phone: 1-866-362-2851
Purple 2 Video Phone: 512-271-9391
Online Intake available 24/7: intake.DRTx.org

Disclaimer: Disability Rights Texas strives to update its materials on an annual basis, and this form is based upon the law at the time it was written. The law changes frequently and is subject to various interpretations by different courts. Future changes in the law may make some information in this form inaccurate.

The form is not intended to and does not replace an attorney’s advice or assistance based on your particular situation.

To request this form in ASL, Braille, or as an audio file, contact us.