ADA Reasonable Accommodation


Our Prohibiting Discrimination on the Basis of Disability and Accommodation Request / Grievance Procedures policy offers complete details of Benton PUD’s procedures for accommodating a reasonable accommodation request.

If a reasonable accommodation is required to ensure access to Benton PUD employment, services, programs and activities in accordance with Title II of the Americans with Disabilities Act, please submit the following accommodation request form as soon as possible to the following address:

Benton PUD Human Resources Manager,
2721 West 10th Avenue, Kennewick,
WA  99336,
fax to (509) 582-1246 or
email to Wennerm@bentonpud.org.

1Reasonable Accommodation Request
2Contact Information

Contact Information

*First Name
 
*Last Name
 
*Address
Apartment
*City
*State
*Zip code
*Email Address
*Phone Number
*Request Date
*Please Contact me by

The completed Request for Reasonable Accommodation form shall be submitted to the ADA Coordinator as soon as possible but no later than ten (10) business days before a scheduled event. Requests received later than ten (10) business days will only be considered and granted when possible, as determined by the ADA Coordinator and General Manager.


Meeting Date
Time
Location of Meeting
Name of Service/Program/Activity
Date of Service/Program/Activity
Position Title
Assistance with (check all that apply):

Describe the specific limitation and the type of accommodation requested, with an explanation of how the accommodation will assist in the application/hiring process or participation in a service, program, or activity.


Note: Verification of the disability by the requestor's healthcare provider may be required.

I declare under penalty of perjury under the laws of the State of Washington the foregoing is true and correct


*Name Of Requestor