Reasonable Accommodation Request Forms

To complete a fillable form:

  • Open the form.
  • Click on "open with different viewer" (located in upper right hand corner of the screen) and then "OK" This will highlight the fillable sections of the form. Note: this may save to your downloads arrow.
  • Select "Open with Adobe Acrobat 8.0” or “save” the form first to your computer (default).
  • Complete the form and save. Print the Healthcare Provider Release Form to sign the document. Original signature is needed.
  • Return forms to the EEO/ADA Compliance Officer, Affirmative Action and Equity office, 105 Main Street, Thompson Hall 305, Durham, NH or fax to (603) 862-2936.
  • The accommodation request documents contain protected medical information – do not email.


Please contact Affirmative Action and Equity if you have any technical difficulties. You can certainly just print the form and fill it out by hand.