Communicable Disease Accommodation Request Form

Name*

First Name

Last Name

ID*

Email*

Faculty/Staff/Student*

Faculty Staff Student

Are you requesting an exception to a present or anticipated requirement to be physically working or attending school or living on a WWU campus?*

Yes No

Which campus do you work at or attend classes on?*

College Place Portland Rosario Montana - Billings Montana - Missoula

Please explain

Employment *

Full-time Part-time

Which category do you classify your request?*

Your own health risk as quantified by the CDC: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-at-higher-risk.html Elderly Care - You are the primary caregiver in residence for an at-risk individual

What accommodations are you requesting? *

Upload verifiable documentation of your health risk condition, your childcare/elderly care needs, or other related information. Anything you provide in this form or in subsequent communication with WWU employees will be kept confidential to the greatest extent possible.*

No File Chosen

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COVID-19 Accommodation Request Form