ADA Request form

If you believe you may need an employment accommodation because of a disability, please complete the following form. The information you provide will assist the ADA Coordinator in determining whether, and/or to what extent, reasonable accommodations may be required for you to perform the essential functions of your job.
If you would like to discuss your situation before completing the form or have any questions about the accommodations process, please email or call 573-341-7734. 

Policy to reference: 600.080 Policy Related to Employees with Disabilities

The ADA Coordinator will keep this form separate from your personnel file and will not share this form with your supervisor unless you give permission. However, the information you provide may be shared with your healthcare providers.

ADA Request Form