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Request Form

The purpose of this form is to assist you in developing a flexible work arrangement proposal for your supervisor’s consideration. The information you provide is intended to be the basis of a dialogue with your supervisor. Your request will be sent to your supervisor at the email address you provide below.

Tip: Use a document software program (e.g. Word) to write answers to longer questions. If a technical glitch occurs, you will have a back-up.

Note: If this request is related to a medical leave or disability accommodation, do not complete this form. Contact Medical Leaves Administration for guidance at 255-1177 or benefits@cornell.edu.

Personal devices used for business will not be subsidized by the university. See Mobile Communication Devices.
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