UMKC Employee Disability Consultation & Accommodations

Identifying Information

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First and Last Name:

Supervisor's Name:

Employee (Your Own Name) & Supervisor(s)

Please provide your name and the name(s) of your supervisors. Please note: we will not contact your supervisor(s) unless you indicate to us that you would like to begin the interactive process of requesting and establishing a workplace accommodation.

First and Last Name

Select Role

Phone Number

Email Address

Additional Information

What are your personal pronouns? We ask to ensure we use appropriate gender references in working to address your concerns. This field is required.

Do you have specific questions about disability accommodations? If yes, please note those questions below. This field is required.

Would you like to request a consultation to determine whether you qualify for a workplace accommodation under the Americans with Disabilities Act (ADA)?(Required)

Yes No Not at this time

This field is required.

Have you discussed any possible modifications to your workspace or job duties with your supervisor? If yes, what were the modifications? Did your supervisor indicate support related to these modifications? This field is required.

Are you contacting us to follow up on a previously approved workplace accommodation? If yes, please share with us the concerns you have related to this accommodation. This field is required.

Supporting Documentation

Please provide any information you believe would be helpful for us to have prior to responding to this inquiry. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Identifying Information

Employee (Your Own Name) & Supervisor(s)

Additional Information

Supporting Documentation

Submission