Carnegie Mellon University

Request for Accommodations Form

Please complete this form to initiate a request for accommodations. An Equal Opportunity Services representative will contact you to begin an interactive process to address your accommodation needs. Disclosure of a disability is voluntary, and the information you provide will be used solely to create an accommodation plan. Please contact the Office of Human Resources at or 412-268-3930 with questions.

By submitting this Request for Reasonable Accommodations, I acknowledge and agree:

  • Reasonable accommodations are determined, identified and implemented in a collaborative process among myself, my supervisor and the Human Resources’ Office of Disability Services;
  • I may not be provided with the specific accommodation that I have requested;
  • I will fully cooperate with Human Resources’ Office of Disability Services in responding to my request, including providing the appropriate medical documentation, if needed;
  • Medical information, including the contents of this request, will be kept confidential and only be shared as needed with the appropriate personnel;
  • The information I provided on this Request for Reasonable Accommodations is complete and accurate to the best of my knowledge.


The Genetic Information Nondiscrimination Act of 2008 (GINA) prohibits covered employers from requesting or requiring genetic information of an individual or an individual's family member, except as specifically allowed by this law. To comply with GINA, the University asks that employees not provide any genetic information when completing this form. "Genetic information," as defined by GINA, includes an individual's family medical history, the results of an individual's or family member's genetic tests, the fact that an individual or an individual's family member sought or received genetic services, and genetic information of a fetus carried by an individual or an individual's family member or an embryo lawfully held by an individual or family member receiving assistive reproductive services.