Accommodation Request Templates
Fill-in-the-blank templates for requesting accommodations at work or school. Use the "Print this template only" button on any section to print just that one, or "Print All Templates" to print everything.
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Template 1: Flexible Work Schedule
I am writing to request a flexible work schedule as an accommodation. Due to a medical/neurological condition, I experience varying energy and focus levels throughout the day.
I am requesting the ability to:
This would allow me to maintain productivity and well-being while continuing to meet my responsibilities. I am happy to discuss specific arrangements and trial periods.
Thank you for considering this request.
Template 2: Sensory Adjustments
I am writing to request reasonable adjustments to my work/school environment to support my sensory needs.
Specifically, I am requesting:
These adjustments would enable me to focus and perform more effectively. I am open to discussing alternatives that may better suit the workplace.
Thank you for your understanding.
Template 3: Written Instructions & Processing Time
I would like to request the following accommodations related to communication and task completion:
- Written instructions for tasks and projects, in addition to verbal briefings
- Advance notice of meeting agendas and discussion topics when possible
- Extended processing time during meetings or discussions (or follow-up via email)
These adjustments would help me process information effectively and deliver my best work.
Template 4: Break & Regulation Schedule
I am requesting the ability to take short, regular breaks throughout the day as an accommodation. These breaks help me regulate sensory input and maintain focus.
Proposed arrangement:
I will ensure my work responsibilities are covered and am happy to discuss how to implement this without disruption.
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