Accommodation & Leave Requests

Request Remote Work as Accommodation

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Recipient Name

Condition Impact

Benefits

Your Name

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Dear [Recipient Name],

I am requesting remote work as a reasonable accommodation under the ADA for my qualifying condition.

My condition [Condition Impact] makes it difficult to work effectively in the office environment. Working remotely would allow me to [Benefits] while continuing to fulfill all essential functions of my role.

This accommodation is supported by my healthcare provider. I can provide documentation upon request. I am open to a trial period or hybrid arrangement to demonstrate that I can effectively perform my duties remotely.

I look forward to engaging in the interactive process to discuss this accommodation.

Sincerely,
[Your Name]

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