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(Please note that while your dean or supervisor will be involved in the process, information about your medical condition, including medical documentation, will not be shared unless authorized by you.)
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Information About Your Accommodation Request
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Are you requesting an accommodation because you are 65 years old or older and therefore at high risk as defined by the CDC?
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If your request is based solely on the fact that you are 65 or older, you will NOT be required to submit the Medical Information Request form.
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What is the underlying condition for which you are requesting an accommodation?
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Are you requesting to work remotely?
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I understand this is a legal representation of my signature.
Clear
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Vanderbilt provides reasonable accommodations due to COVID-19 to qualified employees. In general, it is the employee’s responsibility to inform his/her supervisor that he/she needs a COVID-19 related accommodation. A supervisor is not required to provide reasonable accommodations if he/she is not aware of the employee’s need and desire for the accommodation. Reasonable accommodations are determined, identified and implemented in a collaborative process among the employee, supervisor and the Equal Employment Opportunity Office (EEOO). All medical documentation and information should be shared solely with EEOO, not the supervisor.
Contents of this request are confidential and will only be shared as needed with the appropriate personnel to consider the implementation of a reasonable accommodation. This form will not be placed in your employment record file. All medical documentation will be kept confidential.
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