A form for private sector employees to request an accommodation or exemption from a COVID-19 vaccination requirement. Employers can use this form to address requests for religious accommodations under Title VII, disability accommodations under the ADA, accommodations under applicable state law, and requests for other exemptions or exceptions allowed under an employer's mandatory vaccination policy. This Standard Document applies to private workplaces, including federal government contractors, and is based on federal law. State or local law may impose additional or different requirements. For forms to be used with federal public agency employees, see Standard Documents, Federal Sector Employee Request for Medical Exception to COVID-19 Vaccination Requirement and Federal Sector Employee Request for Religious Exception to COVID-19 Vaccination Requirement. This Standard Document has integrated notes with important drafting tips and explanations.