• Human Resources

  • 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 Form and 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 
    2495 Amsterdam Avenue, BH 204 
    New York, NY 10033 

    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 Human Resources at 646-592-4335.

Yeshiva University
500 West 185th Street
New York, NY 10033
212.960.5400

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