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Important Information

Please fill out this form to request that you be provided with a reasonable accommodation(s) to perform the essential function(s) of your job. If you are applying to a position with any IU campus and are requesting an accommodation for the application or interview process, please select the campus you are applying to below and choose the “Applicant” option under Current Position.

Upon submitting this form, the information will be sent directly to the appropriate Accommodation Specialist for your campus, who will outreach to you to continue the accommodation request process. Your records will be maintained in accordance with applicable confidentiality requirements. During the process, the Accommodation Specialist will:

Review the information you submitted in the form and arrange a follow-up discussion with you to gather additional information.
Collect a copy of your job description and relevant medical documents if needed.
Reach out to the appropriate person(s) in your unit or department to discuss the request and determine if the proposed accommodation or an alternate accommodation may be provided.
Send notice of any approved accommodations to you and your supervisor.

For more information on resources and contact information for the Accommodation Specialist(s) on your campus, please visit ADA.iu.edu.

Indiana University Campus Selection

Select IU Campus (* required)

Submitter's Information

First Name (* required)

Last Name (* required)

Email Address (* required)

Title/Position (* required)

Current Position (* required)

Telephone Number (* required)

Supervisor Name (* required)

Supervisor Title (* required)

Supervisor E-mail (* required)

General Questions

Please describe the nature of the condition and how it has interfered with your ability to perform the essential functions of your job. (* required)

Please describe what accommodation(s) you are requesting that will allow you to perform the essential functions of your job. (* required)

Please note, the accommodations requested will not be automatically granted, but will be considered as suggestions during the interactive process with the appropriate Accommodation Specialist.

Acknowledge and Submit

Please hit submit to send this information to the appropriate Accommodation Specialist.

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