ADA Reasonable Accommodation Request Form

UMass Dartmouth provides equal employment opportunities to qualified disabled individuals. A "qualified" disabled person is one who can perform the essential functions of the job with or without a reasonable accommodation. "Reasonable accommodation" is defined as an accommodation that does not pose undue hardship on the University. "Undue hardship" is a practice, procedure, or financial cost which unreasonably interferes with business operations at the University.

In accordance with the Rehabilitation Act of 1973, and the Americans with Disabilities Act (ADA), UMass Dartmouth defines a disabled individual as "any person who has a physical or mental impairment which substantially limits one or more of such person's major life activities, has a record of such impairment, or is regarded as having such an impairment." These terms are defined as follows.

1. "major life activities" include, but are not limited to, functions such as caring for one's self, performing manual tasks, walking, seeing, hearing, speaking, breathing, and learning.
2. "has a record of such impairment" includes records which predate the relevant law and includes disabilities with which the individual is no longer afflicted.
3. "is regarded as having such an impairment" refers to those individuals who are perceived as having a disability, regardless of whether the individual has a disability.

To request a reasonable accommodation at UMass Dartmouth, complete this form and hit "Submit Form". Your request will be e-mailed directly to the Office of Equal Opportunity, Diversity & Outreach. You will need to submit your physician's or other appropriate health care provider's letter verifying your disability to our office separately. It should also explain the need for accommodation based on your responsibilities and the expected duration of time of the accommodation. As an alternative, you may print out and return the print form (see attached!).

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