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Request for Reasonable Accommodation - DHR EO 013 <br />Employee <br />Page 2 of 3 <br />Type of Accommodation Requested: <br />Is your request time sensitive? ❑ Yes <br />CONFIDENTIAL <br />❑ No <br />If yes, please explain and provide date accommodation is needed. <br />Do you have any suggestions for options we can explore? <br />❑ Yes ❑ No <br />If yes, please explain: <br />Reason for the Accommodation Request <br />Why are you requesting this accommodation? <br />Signature Date <br />