Religious Accommodation Request Form
The Office of Equity and Access (OEA) provides accommodation for employees and applicants (of Stony Brook University, including University Hospital, the Health Science Center, and the Long Island State Veteran's Home) who seek accommodation based on their religious observance or practice. Employees or applicants with questions should contact OEA  at 631-632-6280, or email oea@stonybrook.edu for more information.

Please note that religious accommodations related to federal, state, or local vaccination mandates are not being reviewed using this form.  Please contact oea@stonybrook.edu with any questions, please include your name and SBU ID number with all correspondence.    

Once submitted, a specialist will contact you to schedule a consultation within 5 business days of submission. 

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Name *
SBUID *
Email *
Please use your SBU issued email address. For employees who have not been assigned employee email address, you may use your personal one.  
Job Title *
Name of Supervisor *
Employer *
Department *
Location *
Preferred contact number *
Please identify the work requirement, function, policy, or practice that conflicts with your sincerely held religious observance, practice, or belief (hereinafter "religious beliefs") *
Please describe the nature of your sincerely held religious beliefs, practices, or observances that conflict with the work requirement, function, policy, or practice identified above. *
What is the accommodation or modification that you are requesting? *
List any alternative accommodations that also would eliminate the conflict between the work requirement, function, policy, or practice and your sincerely held religious belief(s). *
Signature / Certification (please type electronic signature) *
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