This form should be completed by the employee requesting reasonable accommodation for a disability or pregnancy-related condition.
All confidential information received by department personnel pertaining to your request shall be handled as such. All medical information is confidential and maintained separately from personnel records.
Note: Application for reasonable accommodation may be made to the supervisor or directly to the Responsible University Official as set forth in the University’s Policy & Procedure on Reasonable Accommodations for State Employees. If the request is made to the supervisor, the supervisor must forward the request to the Responsible University Official.
Please contact benefits@albany.edu with any questions. Visit albany.edu/human-resources/accommodations for detailed information.