This form should be used by Seminary employees who wish to request a reasonable accommodation under the Americans with Disabilities Act (ADA), the Illinois Pregnancy Accommodation Act, or other applicable State and Federal civil rights laws. The purpose of this form is to assist the Seminary in determining whether, or to what extent, a reasonable accommodation is appropriate for a qualified Seminary employee or applicant for employment.

Please note this form is considered confidential and will be placed in the employee's confidential medical file and not in their personnel file.