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Office of Equal Opportunity, Diversity & Outreach

REASONABLE RELIGIOUS ACCOMMODATION REQUEST FORM

To make a reasonable religious accommodation request, please complete this form and hit "Submit Form". Your request will be e-mailed directly to the Office of Equal Opportunity, Diversity & Outreach.As an alternative, you may print out and return the print form (see attached!).

In accordance with federal and state laws and University of Massachusetts Board of Trustees policies, the University of Massachusetts Dartmouth prohibits discrimination on the basis of religion. The University provides reasonable accommodations for members' sincerely held religious beliefs or practices unless doing so would impose an undue hardship on the University. A reasonable religious accommodation is any adjustment to the work and/or academic environment that will allow the individual to practice his/her religion. "Undue hardship" is a practice, procedure, or financial cost which unreasonably interferes with business operations at the University.

Fields marked with * are required.

Your Name: *
Enter your name. Required.
Title/Position: *
Department: *
Work Phone Number:
Home Phone Number:
Please specify the religious belief/practice you have for which you are requesting accommodation.
What reasonable accommodation are you requesting at this time? What are some accommodation options?

The Office of Equal Opportunity, Diversity & Outreach will review your request, and you will be contacted to discuss your requested accommodation. This information will be maintained confidentially to the extent practicable under the circumstances.

The above information is complete and accurate to the best of my knowledge and belief.

Your email address: *
Enter your email address. Required.

Contact Info: