Employee Disability Accommodation Request Form

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The Office of Equity and Access provides accommodation for employees with disabilities (staff, faculty, and student employees) and applicants for employment. Employees should contact the ADA Specialist for Stony Brook University, Stony Brook University Hospital, HSC, and the LISVH at 631-632-6280, or email oea_ada@stonybrook.edu for more information.

Once submitted, the ADA Specialist will contact you to schedule a consultation, upon receipt of this form.

Email *

Your Name *

SBU ID Number *

Current employees and students can find the SOLAR ID number on their Stony Brook ID Card. Otherwise, you may reach out to your Department/HRS/VP Coordinator for your SOLAR ID number.

Department *

Your employee title

Employed by:

Supervisor *

Work Address

Location

You preferred contact number

Are you currently on Short Term Disability?

Yes

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