Reasonable Accommodation Notice
OMB Control Number 1250-0005
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.
 Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp
PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.
Please Contact Sherrill Brown, Assistant Director of Human Resources, in the Office of Human Resources at 518-786-5063 or at firstname.lastname@example.org if you require a reasonable accommodation.
As a student with a disability, you may be entitled to academic accommodations as well. For more information please contact the Director of the Services for Students with Disabilities Office at 518-783-4239.