Employee Reasonable Accommodation Request

Required

St. Francis Area Schools
Employee Reasonable Accommodation Request
Namerequired
First Name
Last Name
describe the nature, extent, and duration of your disability (or member of household disability).
describe the accommodations you that are needed to enable you to perform your job.
Medical Documentation
Please provide medical documentation of your qualifying disability (or member of household qualifying disability) and upload it below.
Attach up to 5 files at a time. File size may not exceed 10MB
No file chosen

 

Physician Contact Information
Your physician may receive a letter/fax from the District requesting information on your (or member of household) impairment/ disability and recommendations for accommodations. Authorization will be requested prior to contacting this individual.

 

Must contain a date in M/D/YYYY format