The University is committed to and recognizes the importance of providing work-life support and workplace flexibility for nursing mothers. The Break Time for Nursing Mothers Policy provides reasonable break time for mothers to express breast milk for up to one year following the birth of a child.

To request an accommodation please complete and submit this form. A copy of this form will be forwarded to your supervisor and the Equality Administration Office. Nursing mothers shall discuss their accommodation request with their supervisor so that appropriate accommodations can be arranged.

Required questions are marked with an (*).

* Employee Name (You must type in a response)
	Name of the employee requesting accommodation
* Employee UMID: (You must type in a response)
	Employee's UMID
Department Name (Type in a response)
* Work Phone # (You must type in a response)
Job Title (Type in a response)
	Job title of the employee requesting accommodation
* Select Employment Status: (Select only one)
	Full-Time Regular Part-Time Regular Temporary/Casual Worker
* Supervisor/Department Head: (You must type in a response)
* Supervisor Email Address (You must enter a valid email address)
* Select Nursing Mothers Room Location: (Select only one)
	Employee Private Office Canterbury Pre-School Clinical Research Building Dominion Tower Gables One Tower McKnight Building Richter Library Rosenstiel Medical Science Building Science Library Administration Building University of Miami Hospital Rm 780 University of Miami Hospital Rm 1320
* Include days and times that you would like to use the Nursing Mothers Room. (You must type in a response)
	Enter the calendar date you would like the accommodation to begin and end.
* Enter Begin Date (You must type in a response)
* Enter End Date (You must type in a response)
* Enter Child's Birth Date (You must type in a response)