Religious Accommodation Request

A reasonable religious academic/workplace accommodation is a change in the academic/work environment or in the way academics, tasks or responsibilities are customarily done that enables a student/employee to participate in his/her religious practice or belief without undue hardship on the conduct of Johns Hopkins University's business or operation.

To consider your request for a religious academic/workplace accommodation, please provide the following information:

Name
Pronouns (i.e. she, they, he, ze, per, etc.)
Date of Request
School
Department/Work Unit (please do not abbreviate)
If you are a student, what year are you in?
Telephone or Cell Phone Number
Email Address (HIDDEN)
Email Address
Hopkins Affiliation
Are you requesting an influenza vaccine exemption?
Are you requesting an exemption from JHU's required immunizations (measles, mumps, rubella, or meningitis)?
Reason for Request (please explain how your need for a religious accommodation is connected to your sincerely held religious beliefs): *

Before approving religious accommodation requests, we are required to engage in an interactive process where you share the reason for your request. In this way, please explain in as much detail as possible how your request is connected to your sincerely held religious beliefs. Should we require additional information, we will contact you via e-mail and/or phone.
Suggested reasonable accommodation to meet your requirements or limitations:
Is this a temporary or permanent accommodation (i.e., annual religious event, daily religious requirement)?
Length of Time
Days Affected
Shifts (if applicable)
If requested, can you obtain documentation or other authority to support the need for an accommodation based on your religious practice or belief?

If requested, can you obtain documentation or other authority to support the need for an accommodation based on your religious practice or belief? Yes No
Verification and Accuracy *

Verification and Accuracy I verify that the above information is complete and accurate to the best of my knowledge and I understand that any intentional misrepresentation contained in this request may result in disciplinary action.* I also understand that my request for an accommodation may not be granted if it is not reasonable or if it creates an undue hardship on my employer/academic environment.*
Signature
Date Date / MM / DD YYYY
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