Continuum Accommodation Form

Date Accommodation Needed:

Date Completed:

Name:

Personal Email:

Phone Number:

Work Location:

What specific accommodation(s) is the new hire requesting?
(Please check all that apply)
InterpreterQualified ReaderScreen reading softwareTask lightingComputer Braille displayLarger monitorFacility accessibilityService animalHand, stand, or portable magnifierMonitor screen filterLarge print documentsTelephone light sensorOther (please describe):

Continuum
Accommodation Form

PLEASE COMPLETE ONLY IF YOU ARE SEEKING A WORK ACCOMMODATION

Information on Accommodation