PDF
…seeing, speaking, learning, sitting, and caring for self.
Yes
No
Does the disability affect your ability to perform the essential functions of the job?
Yes
No
Have you applied for FMLA for the same disability or condition?
Yes
No
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WORKPLACE ACCOMMODATIONS
Employee Request (ER) Form
Revised: 6/2026
What, if any, job functionsare you…
https://www.wichita.edu/services/humanresources/Total_Rewards/Leave/ADAAA/ADA_Accommodation_Employee_Request_Form.pdf