Reasonable Accommodation Request Form

* indicates a required field

Confidentiality Statement

At Lehigh University, anyone who handles personal information about students or other staff members has the obligation to maintain strict confidentiality and to comply with the requirements of the Family Educational Rights and Privacy Act (FERPA) and the Health Insurance Portability and Accountability Act (HIPAA). If you have questions, please contact


New Requests

Please be aware that this form is for NEW requests only. If you need to renew your accommodation or request an additional accommodation, please log in to your Accommodate Account and submit a supplemental request.

Your Employee ID/LIN # can be found by logging into Lehigh Connect, going to Employee Self Service and clicking on My Profile.
Please use your Lehigh University email.

Accommodation Specific Information

Does your request include accommodations for parking and/or transportation on Lehigh’s campuses?Required
If unsure about the potential accommodation(s), do you have any suggestions for options to explore?Required
Have you had any work-related accommodations in the past for this same limitation?Required

By signing this form, I certify that the information provided in this form is true, complete, and accurate. I acknowledge that I am requesting a reasonable accommodation under the Americans with Disabilities Act. I agree to cooperate fully with the Office of Human Resources in responding to my request, including providing the appropriate medical documentation from my health care provider(s). I agree that I will provide the requested medical documentation in a timely manner. I understand that while the University may not grant the specific accommodation that I have requested, it will engage in good faith efforts to make a determination. I also understand that, in some cases, discussion(s) with my physician may be necessary to address my request for accommodation. In addition, if deemed necessary, the University may request an independent medical evaluation of the case.

Please type your name to act as an electronic signature.