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Please complete the following and use the "submit" button to send your request for information to the JAN staff. Your request will be forwarded to a JAN Consultant who will e-mail a response.

Your Name:

Your E-mail Address*: (Required)
Please double check your e-mail address.

Your State:

I am contacting you as:

an employer,

an individual with a disability,

a rehabilitation professional,

a family member or friend, or

other.

If your question concerns a workplace accommodation, please complete as many of the following six items as applicable

OR

go to the bottom of the form to submit a question related to the Americans with Disabilities Act, the Rehabilitation Act, or related legislation.

1. Please describe the disability or limitation of the person who is having a problem related to work. (For example, uses wheelchair and recently has developed limited use of left hand.)

2. What is the job title of the employee?

3. What specific duties are an issue? (For example, must type approximately 6 hours per day at 50 wpm OR due to medication needs to work straight schedule and laborer job requires rotating shift.)

4. What equipment or physical barriers used in the work setting are an issue (specific equipment with make and model when possible)?

5. What company policy is related to the need for accommodation? (For example, attendance policy.)

6. List/summarize any accommodations that have been attempted or requested.

Please enter your accommodation, ADA, or legislation question in the following box.*
*Note: JAN can provide information regarding the Americans with Disabilities Act, but JAN is not a legal service so cannot provide legal advice. If you need legal advice, you should consult a legal service.

Please click the submit button to forward your request. Thank you for contacting the Job Accommodation Network.

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