Princeton University provides reasonable accommodations for employees and individuals to whom a job offer has been made who have a disability. In determining which accommodations are reasonable, the University and the employee have a mutual obligation to engage in a good faith interactive process to explore and discuss options for reasonable modifications. Your request for a reasonable accommodation, and any information submitted in support of or related to the request, will be kept confidential, except when it needs to be shared with University officials who are involved in evaluating and/or implementing the request. For questions regarding policy 5.1.7 Reasonable Accommodations for Disability or the interactive process, contact HR at (609) 258-3300 or [email protected]. For questions related to your medical information, email Occupational Health Services (OHS) at [email protected].Both the employee and healthcare provider forms must be received and reviewed by Occupational Health Services in order to begin the interactive process:Complete and submit this "Request for Accommodation" webform that goes directly to OHS.Give your healthcare provider either a printed copy of the Healthcare Provider Form for Accommodations or a link to it. You must sign the form before your provider sends it to OHS.Give your healthcare provider a copy of your current job description. You should ask your supervisor for a copy if you do not have it. Date First Last Position Email Telephone # Department Supervisor Campus Address 1. Describe any limitations resulting from your condition(s) that interfere with your ability to perform the essential functions of your position. : 2. Describe the accommodations you believe are needed to enable you to perform the essential functions of your position. : Do not include any medical information on this form. Medical information should be provided only on the healthcare provider’s form. By submitting this completed and signed form to Occupational Health Services (OHS) and the Human Resources Manager of Faculty and Staff Accommodations, I understand and agree that:I am beginning the interactive process, which is a collaborative process between me and the University to determine the need for and explore options for reasonable accommodations.I am responsible for giving the Healthcare Provider Form for Accommodations to my healthcare provider to complete.I must sign the Request for Medical Information from Healthcare Provider form before it is sent to OHS.I am responsible to make sure that either I or my healthcare provider sends the completed and signed Request for Medical Information from Healthcare Provider form to OHS.The Human Resources Manager of Faculty and Staff Accommodations may receive and discuss with OHS relevant information relating to my accommodation request, including medical information submitted by my provider.Reasonable accommodations are determined in consultation with appropriate University professionals. The Human Resources Manager of Faculty and Staff Accommodations may discuss relevant non-medical information with University personnel who are involved in evaluating and/or implementing my accommodation request. Information will only be shared on an as-needed basis with the objective of determining reasonable accommodations and providing equal access. I certify the below signature constitutes as a legal signature, and that my electronic signature is equivalent to a handwritten signature. Electronic Signature: CAPTCHA Leave this field blank Related links Healthcare Provider Form for Accommodations
