Office of Human Resources Employee Relations
Religious Accommodation – Request Form
General Mailbox: EmployeeRelations@depaul.edu Phone: (312) 362-8577 Fax: (312) 476-3232
If you would like to make a request for reasonable accommodation, please complete this form and submit it to the
Office of Human Resources, Employee Relations, to allow us to work together to address your request to
accommodate your religious practices.
Name: ____________________________ Title/Position: ______________________ EMPLID: ____________
Work Phone Number: ___________________________ Email: ________________________________________
Department: ___________________________ Manager: ______________________ Manager Ext. ___________
Please specify the religious belief, practice or observance obligation that is the basis for your request for
accommodation.
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Please specify the work requirement that conflicts with the religious belief, practice or observance obligation
described above and explain the nature of the conflict.
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Please describe the specific accommodation that you are requesting at this time, including an explanation of how the
requested accommodation will enable you to meet your religious obligations without impacting your ability to meet
the required functions of your job.
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What are some other accommodation options that might address your needs?
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If you have requested religious accommodation before, please state approximately when the request was made, the
name of the individual who responded to the request, and the outcome of the request.
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Additional Comments
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The Office of Employee Relations will:
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Review your religious accommodation request.
If necessary, participate in a conversation with you to learn as much as possible about the request
accommodation, as well as determine a reasonable and appropriate accommodation. In some cases, you
may be asked to provide documentation or other authority to support the accommodation request.
Provide coaching and guidance on communicating the Religious Accommodation need to the
manager/supervisor.
Contact you as to the status of your request within ten (10) business days upon receipt of the religious
accommodation request.
Decide what accommodation, if any, will be granted. An accommodation may be offered on a temporary
basis and re-evaluated periodically. An accommodation may not be granted if it is unreasonable or creates
an undue hardship.
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Employee Signature
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Date
Confidentiality
Materials related to an employee’s religious accommodation request, including the written request for accommodation and any other
documentation/information, will be kept confidential, but may be disclosed for University/department business reasons or as necessary to
effectuate the accommodation. For additional information, please contact Employee Relations at (312) 362-8577. Requests may be sent via
email to EmployeeRelations@depaul.edu or faxed to (312) 476-3232.
Updated 4/20/2011