Religious Accommodation Request Form

Collects employee requests for religious accommodations related to schedules, attire, grooming, observance, and other workplace practices.

Employee Information

• Employee Name
• Work Email
• Employee ID
  Optional. Provide only if your organization uses employee IDs for HR routing.
• Department
• Manager Name
• Preferred Contact Method

Request Details

• Type of Accommodation Requested
• Workplace Rule, Schedule, or Practice That Conflicts
  Briefly describe the policy, schedule, dress code, grooming standard, or practice that creates the conflict.
• Requested Accommodation
  Describe the specific change or exception you are requesting.
• Requested Start Date
• Requested End Date
  Leave blank if the accommodation is ongoing.
• Reason for Urgency
  Optional. Use only if the request needs prompt review.

Religious Practice or Observance Details

• Which area does this request relate to?
• Dates or Times Affected
  List the dates, times, or recurring schedule impacted by the request.
• Dress or Grooming Details
• Schedule Details
• Other Details

Work Impact and Alternatives

• Essential Job Functions or Work Duties Affected
  Describe any duties, shifts, or workplace requirements affected by the request.
• Alternative Accommodations to Consider
• Additional Alternative Details
• Previous Accommodations or Related Requests
  Optional. Describe any prior accommodations that are relevant to this request.

Supporting Information

• Supporting Documents
  Optional. Upload any supporting documentation if your organization allows it.
• Additional Comments

Acknowledgment and Consent

• I confirm the information provided is accurate to the best of my knowledge.
• I consent to HR reviewing this information for the purpose of evaluating my religious accommodation request.
• I understand HR may contact me for limited additional information or to discuss possible accommodations.