Disability Accommodations Forms

FACULTY, STAFF & APPLICANTS:

When requesting an accommodation in employment under the Americans with Disabilities Act, the following forms must be completed:

1. Disability Accommodations Request Form (PDF)
To be completed by Employee

2. Disability Accommodations Health Care Provider Release Form (PDF)
To be completed by Employee

3. Disability Accommodations Health Care Provider Statement Form (PDF)
To be completed by Health Care Provider


FACULTY & STAFF: 

Employees shall follow these three (3) steps when requesting an accommodation:

1. The employee must complete the Disability Accommodations Request Formand submit it to their immediate Supervisor, Chairperson or Dean.

2. The employee must forward a completed copy of the Disability
Accommodations Health Care Release Form along with a blank copy of the
Disability Accommodations Health Care Provider Statement Form to his/her
Health Care Provider.

3. All completed forms, assessments, records and information should be
forwarded to:

Chief Human Resources Officer
Yeshiva University
1300 Morris Park Avenue, Suite 1209
Bronx, New York 10461

APPLICANTS:  

When seeking an accommodation for the job application process, applicants should contact the HR Recruitment Services Director.

For assistance in completing any of the forms, please contact the Office of Diversity & Affirmative Action at 718-430-3771.