403.7E3 - Religious Accommodation Request Form - Currently Suspended

 

RELIGIOUS ACCOMMODATION REQUEST FORM

Date:
Employee Name:
Email Address:
Position/Job Title:
Employee Telephone Number:
Employment Location:

 

(1) Please identify the policy requirement or practice that conflicts with your sincerely held religious observance, practice or belief:

(2) Please describe the nature of your sincerely held religious beliefs or religious practice or observance that conflict with the policy or practice you have identified above:

(3) What are you requesting an accommodation from?

 

Item	Yes/No
Vaccination for COVID-19
Testing for COVID-19
Use of Face Coverings

 

___________________________________  ________________________________

Employee Signature Date
Office Use

This request has been:

______________________________  ________________________________

Approved Denied

_________________________________________  ______________________________

Administrator Date

 

 

This policy was suspended at the January 12, 2022 Board meeting.