San Mateo County Community College District Applicant Reasonable Accommodation Request Form Header Image

Applicant Reasonable Accommodation Request Form

Name
Interview Date
Address

General: The San Mateo County Community College District is committed to providing the most appropriate accommodations for our employees and applicants for employment based on state and federal guidelines. The applicant and Human Resources will engage in the interactive process in order to provide an appropriate accommodation. 

You are encouraged to contact Human Resources to discuss your questions regarding accommodations. Your request will be given thorough consideration. The Human Resources Representative may discuss alternatives with you and/or contact you for additional information before a decision is reached.


Reasonable Accommodation Request: (check all that apply):
I am requesting an accommodation to complete the employment application/testing process.
What type of accommodation(s) do you need? (This is not an all inclusive list of possible accommodations)

Please provide us with the name of your health care provider(s) who can assist in this process.

Name of Health Care Provider
Health Care Provider Address
PLEASE BE PREPARED TO PROVIDE DOCUMENTATION OF YOUR PROTECTED STATUS *
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Please attach medical documentation on official letterhead explaining the functional limitation(s) your disability creates upon your ability to complete the application/testing process; and/or, ability to access our facilities.
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For HR Use Only

Date
Additional Medical Documentation Required:
Accommodation Approved:
Date Applicant Notified
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