• Knox College Accommodation Request Form

  • Personal Information

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  • What type of accommodation(s) do you need?*

  • Health Care Provider

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  • Major Life Activities

  • Please note the major life activity that is affected (if any)?*

  • Is your medical condition temporary?*
  • Are you currently working?*

  • I hereby certify that I believe I am a qualified individual with a disability as defined by the law. I require an accommodation to perform the essential functions of my position. I understand that a detailed review of my disability status may be required, and I agree to cooperate fully in this process. I further understand that if my request is granted, I am obligated to report any changes in my disability status which may require a re-evaluation of this request. Granting of this request does not signify approval of any future reasonable accommodation request for any other position within the College.

  • Date:
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  •  :

  • For additional information, please contact Office of Human Resources at 309-341-7200.

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