This form is the initial step in processing your request for accommodation under the Americans with Disabilities Act (ADA). An accommodation is a reasonable modification or adjustment to the work environment that enables a qualified person with a disability to perform essential functions. In order to determine whether you are eligible for an accommodation under the ADA, Human Resources will ask for documentation of your medical condition. Under the ADA, an individual with a disability is a person with a physical or mental impairment that substantially limits one or more major life activities, such as breathing, eating, sleeping, walking, talking, manual tasks, etc.

This form is ONLY for employees of System Administration and will only be viewed by persons in Human Resources or in consultation with the ADA Compliance office at the University of Colorado Boulder. By submitting this form, I recognize that I may need to authorize my medical provider(s) to release information to, and if necessary, speak with Human Resources or ADA Compliance about my medical condition to determine appropriate job accommodation(s) for my condition, if the disability is not obvious. Employees who have questions prior to submitting the form may contact Human Resources at

DO NOT submit this form if you are on a campus. If you are on a campus, please visit the sites before for more information on submitting an accomodation request to the appropriate ADA team: