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University of Massachusetts Dartmouth
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Office of Equal Opportunity, Diversity & Outreach
The University of Massachusetts, Dartmouth (“UMass Dartmouth”) provides equal employment opportunities to qualified individuals with a disability. The term “qualified individual with a disability” means an individual with a disability who, with or without a reasonable accommodation, can perform the essential functions of the employment position that such individual holds or desires. A “reasonable accommodation” is defined as an accommodation that does not pose undue hardship on UMass Dartmouth. “Undue hardship” is a practice, procedure, or financial cost which unreasonably interferes with the business operations at UMass Dartmouth.
The definition of “disability” must be construed in accordance with all of the following:
To request a reasonable accommodation at UMass Dartmouth, complete this form and press “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 the Office of Equal Opportunity, Diversity & Outreach separately. The physician’s letter must also explain the need for accommodation based upon your position responsibilities and the expected duration of time of the accommodation. As an alternative, you may print out, sign, date and return the PDF version of this form to:
Fields marked with * are required.
Please submit separately a physician's (or other appropriate health care provider) letter verifying your disability, explaining in detail the recommended accommodation and how the recommended accommodation is necessary based on your disability. This documentation should be typed or printed on letterhead, dated, signed and legible with the name, title and professional credentials of the evaluator or medical provider.
The ADA Coordinator will review your request, and you will be contacted to discuss your requested accommodation.
The above information is complete and accurate to the best of my knowledge and belief. This information will be maintained confidentially to the extent practicable under the circumstances.
Email: webdevelopment@umassd.edu - UMass Dartmouth Web Development Team