Reasonable Accommodation Request Letter (ADA) – Free Template
Use this free sample letter requesting accommodation from employer (United States): fill it in online, download it as Word or PDF, and follow our step-by-step guide – where to send it, whether it needs notarizing, what to attach and mistakes to avoid.
| Country | 🇺🇸 United States |
|---|---|
| Document type | Jobs & HR |
| Format | Word, PDF & fill in online |
| Cost | Free |
| Time to complete | about 5 minutes |
| Notarization | Not required |
What is this letter for?
Under the Americans with Disabilities Act (ADA), employers with 15 or more employees must provide reasonable accommodations unless it causes undue hardship. A written request starts the “interactive process” and creates a record.
Where do you send it?
Send it to HR (or your manager) in writing, by email or letter, to start the ADA interactive process.
Does it need to be notarized?
Not required. No notarization is needed. Your employer may ask for reasonable medical documentation from your provider.
What you need before you start
- The job tasks that are difficult
- The accommodation you are requesting
- Medical documentation if your employer asks for it
How to use this template
- Click each yellow field inside the letter and type your details directly (Enter jumps to the next field).
- Read the text through; the “Edit” button lets you change any sentence.
- Click “Word”, “PDF” or “Copy”, then sign and send.
Free template : sample letter requesting accommodation from employer
Your full name
Street address
City, State ZIP
Phone | Email
Date
HR manager name
Human Resources
Company name
Company address
Re: Request for reasonable accommodation
Dear Recipient name,
I am writing to request a reasonable accommodation under the Americans with Disabilities Act. I have a medical condition that affects my ability to describe the job function affected.
To perform the essential functions of my job as Your job title, I am requesting the following accommodation: accommodation requested, e.g. modified schedule, ergonomic equipment, remote work.
I believe this accommodation will allow me to continue performing my duties effectively. I am happy to provide supporting documentation from my healthcare provider and to discuss alternatives.
Please let me know when we can meet to discuss this request.
Sincerely,
Your full name
⚠️ Disclaimer: this template is for general guidance only and is not legal advice. Always check the requirements of the organization you are writing to before sending it.
Common mistakes to avoid
- ❌ Asking verbally only, with no written record.
- ❌ Not describing which job functions are affected.
- ❌ Missing EEOC deadlines if the request is denied.
Tips before you send it
- You do not have to disclose your diagnosis in the first letter.
- Keep copies of every email and meeting note.
- If denied, you can file a charge with the EEOC within the deadline.
Frequently asked questions
Do I need a doctor’s note?
Your employer may ask for reasonable documentation of the disability and the need for accommodation.
How long does my employer have to respond?
The ADA has no fixed deadline, but unnecessary delays can be a violation; follow up in writing.
Where do I send this letter (sample letter requesting accommodation from employer)?
Send it to HR (or your manager) in writing, by email or letter, to start the ADA interactive process.
Does this letter (sample letter requesting accommodation from employer) need to be notarized?
Not required – No notarization is needed. Your employer may ask for reasonable medical documentation from your provider.