Ampact is committed to the full inclusion of all qualified individuals. As part of this commitment, we will ensure that persons with disabilities or persons needing a religious accommodation are provided reasonable accommodations. An accommodation is a modification or adjustment to a job application, interview process, job duties or the work environment to allow an individual to perform the essential functions of the position.
This form will be used as an initial review for your accommodation request. This is an interactive process to ensure the needs of members, sites, and employees of the organization are considered. In some cases, we may need to consult additional individuals in the process such as site staff. Information will only be shared that is pertinent to reviewing and assessing the request. For the full Disability Accommodtions Policy, please click here.
Please complete the information below to the best of your knowledge. After submitting this request, it will be reviewed by our Accommodations Coordinator who will reach out for additional information or to follow-up.
If you need assistance completing this form, please contact email@example.com.