What is an ADA accommodation request form?

It is the written request you submit to HR asking for a workplace accommodation under the ADA. The law does not require a specific format, but putting the request in writing protects you and creates a record.

How do I fill out an ADA accommodation request form?

State that you are requesting a reasonable accommodation under the ADA, briefly describe your condition without your full diagnosis, name the specific accommodation you want, attach your provider's documentation, and confirm your willingness to engage in the interactive process.

Do I have to use my employer's specific form?

If your employer has a formal accommodation process or form, use it. If not, a clear written request covering the same elements is sufficient. Submitting through HR rather than only your manager is best.

Do I need a doctor's letter to submit the form?

Supporting documentation from a qualified provider makes the request much stronger and is usually expected for medical or mental health conditions. The letter should describe your functional limitations and the accommodation needed.

What happens after I submit the form?

Your employer must engage in the interactive process. They may approve it, request more information, propose an alternative, or deny it for a legitimate reason such as undue hardship. There is no guaranteed outcome.

ADA Accommodation Request Form: How to Fill It Out

Employee filling out an ADA accommodation request form at a home desk before submitting it to HR

There is no official government ADA accommodation request form, and the ADA does not require your request to be in writing at all. But putting your request in writing is the single most useful thing you can do: it creates a paper trail, forces your employer to respond, and gives you documentation if they fail to engage. Below is a free sample you can copy, a plain-language walkthrough of what to include and what to leave off, an explanation of who completes which part, and answers to the questions people ask most.

Is there an official ADA accommodation request form?

No. According to the EEOC's enforcement guidance on reasonable accommodation, a request for accommodation does not have to be in writing and there is no required form or magic language. Your employer may ask you to fill out its own form, and some do, but it cannot ignore a request just because you did not use a particular form. The federally funded Job Accommodation Network also publishes sample accommodation forms that employers commonly adapt. In short: use any clear written format, and keep a copy.

A free ADA accommodation request you can copy

Customize the bracketed parts and send it to your HR contact:

Subject: Request for Reasonable Accommodation under the ADA

Dear [HR contact],

I am writing to formally request a reasonable accommodation under the Americans with Disabilities Act. I have a medical condition that substantially limits [a major life activity, for example my ability to concentrate and manage stress in certain environments].

To perform the essential functions of my job, I am requesting [the specific accommodation, for example full-time remote work, a hybrid schedule, or a modified start time].

Supporting documentation [is attached / will be provided within [X] business days].

I am glad to discuss this and to participate in the interactive process to identify an effective accommodation. Please let me know what additional information would be helpful.

Sincerely, [Your name, job title, date]

How to fill it out: what to include

Keep it short and specific. A strong request has five parts:

A clear statement that you are requesting an accommodation under the ADA. You do not need legal language, but naming the ADA signals that this is a formal request, not a casual preference.
A general description of your condition. You do not have to disclose a specific diagnosis. "I have a mental health condition that affects my ability to concentrate" is enough. For what you are and are not required to share, see do you need a diagnosis for an ADA accommodation.
Your functional limitations at work. This is the most important part. Describe specifically what about the in-office setting your condition makes difficult. For how to phrase this, see what a mental health accommodation letter should include.
The specific accommodation you want. Full-time remote work, a hybrid arrangement, or a modified or reduced schedule. Be concrete.
The status of your supporting documentation. Note whether a provider's letter is attached or will follow.

Writing this yourself can feel harder than it sounds, especially when you're also managing the condition it's about. If you'd rather not start from a blank page, our Accommodation Request Kit gives you 18+ ready-to-edit request templates and conversation scripts, plus the worksheet used to build the example above, personalized to your state for $49.

What to leave off

Your full diagnosis and medical history. You do not owe HR a detailed record. For what an employer can and cannot ask, see can an employer ask for your diagnosis.
Vague preferences. "I work better at home" is not a legal argument. Tie the request to functional limitations.
An adversarial tone. You are inviting a conversation, not threatening one.

Who fills out an ADA accommodation request, and which parts?

People often confuse three separate documents. Different people complete each one:

Your written request. You write this yourself. It is the sample above: your statement, your limitations, and the accommodation you want. The ADA does not require a specific form for it.
Your employer's form, if it has one. Some employers ask you to use their own request form or a medical inquiry form. You can use theirs, but a written request in any format is still valid.
Supporting medical documentation. If your employer asks for documentation that you have a condition and need the accommodation, that part is completed by a qualified healthcare provider, not by you. Mental health conditions are generally best documented by a psychologist or licensed mental health professional; see which credentials are best for an accommodation letter.

If you need that supporting documentation, WorkWell connects you with a PSYPACT-licensed psychologist who can provide it, usually within a few business days. Check your eligibility, or see how long it takes and what it costs.

If you're further along and your provider has already given you documentation, or you're just trying to figure out what to send and to whom, the Accommodation Request Kit also includes a full walkthrough of the submission process, six worked examples covering common outcomes (approval, counter-offer, denial, and more), and a tracker to keep your dates and contacts organized. It's included free with our Complete Support package.

After you submit

Submitting your request starts the interactive process, where you and your employer discuss workable options. For what to expect, see what happens after your employer receives your accommodation letter. If your request is denied, see your accommodation was denied: a step-by-step action plan.

Frequently asked questions

Is there an official ADA accommodation request form? No. The ADA does not require a specific form, and a request does not have to be in writing, though putting it in writing protects you and forces your employer to respond.

Who fills out an ADA accommodation request form? You write the request yourself. Your employer may provide its own form. Any supporting medical documentation is completed by a qualified healthcare provider, not by you.

How do I fill out an ADA accommodation request? State that you are requesting a reasonable accommodation under the ADA, describe the functional limitations your condition causes at work, and name the accommodation you are requesting. You do not need to disclose a specific diagnosis.

Do I have to use my employer's ADA form? You can use your employer's form, but a written request in any format is valid under the ADA.

Do I need a diagnosis on the form? No. You need to establish that you have a recognized condition and describe its functional limitations, as assessed by a qualified provider. A diagnosis label is not required.

Is there a template for the whole accommodation process, not just the request? Yes. The Accommodation Request Kit ($49) is a complete kit, the request form above plus 18+ templates for responding to HR, a personalized state resource guide, and worked examples for different outcomes. It's included free if you book our Complete Support package.