Attachment 7 - Reasonable Accommodations Appeal of Denial


Attachments Page

Attachment 7 - Reasonable Accommodations Appeal of Denial (pdf)


Fields on the form: 
Illinois AmeriCorps Disability Outreach Project

APPEAL OF DENIAL OF REASONABLE ACCOMMODATION REQUEST

  • Member/ Applicant Name:
  • Program Name:
  • Date:
  • Date of denial of reasonable accommodation request:
  • Accommodation that was denied (what was requested?):
  • Reason for appeal:
  • Additional supporting information (attach copies of further medical or supporting information):
  • Alternative accommodation requested:
  • Member/Applicant Signature:
  • Date:

* Send appeal to the Serve Illinois Commission Office *
535 W. Jefferson Street, 3rd Floor, Springfield, IL 62702
(attach a copy of original request and denial)


SIC OFFICE USE ONLY:

  • APPROVED
  • DENIED
  • ALERNATIVE ACCOMMODATION
  • Comments:
  • Signature:
  • Date received: 
  • Date of decision: