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RELIGIOUS ACCOMMODATION REQUEST FORM

DISTRICT OF COLUMBIA GOVERNMENT RELIGIOUS ACCOMMODATION REQUEST FORM DCSF-2021-31 RELIGIOUS A ccommodation REQUEST Form | DCS F No. 2021-31 ( R ev 09/2021) Page 1 of 2 PART 1: Complete this form and submit it to your agency HR representative to REQUEST a RELIGIOUS ACCOMMODATION . A. EMPLOYEE INFO Last Name Middle Name First Name Agency Phone Number Position Title Email B. REQUESTED ACCOMMODATION Please state your requested ACCOMMODATION (job change, schedule change, dress/appearance code exception, vaccination exemption, etc.): Length of time the ACCOMMODATION is needed: Why are you requesting this ACCOMMODATION ? An ACCOMMODATION may be denied if it creates an undue hardship on the agency. For this reason, please describe any alternate accommodations that might address your needs: C.

DISTRICT OF COLUMBIA GOVERNMENT RELIGIOUS ACCOMMODATION REQUEST FORM DCSF-2021-31 Religious Accommodation Request Form | DCSF No. 2021-31 (Rev 09/2021) Page 1 …

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