Forms
Requesting an Employment Accommodation(s) from the EARC
The forms below are for 91ÁÔÆæ employees who:
- Have a disability and want to register with the EARC for the first time
- Are already registered with the EARC and need to request changes or additional accommodations for an existing condition
Note: Being registered with the EARC means you’ve already submitted documentation that confirms your disability status under FEHA and/or ADA.
Registration Forms
Select the type of accommodation(s) you are requesting:
- Disability Related Accommodation
-
: To be completed by the employee requesting disability related accommodations - EARC Verification Form [pdf]: To be completed by the employee’s healthcare provider to verify eligibility for disability-related accommodations
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- COVID Related Accommodation
- ADA/FEHA COVID-19 Disability Accommodation Certification Form [pdf]: To be completed by the employees healthcare provider for COVID-19 related accommodations.
- Emotional Support Animal (ESA) Accommodation
- : To be completed by the employee requesting to register an emotional support animal
as part of their accommodation.
- EARC Emotional Support Animal (ESA) Verification Form [pdf]: To be completed by the employee’s healthcare provider to verify eligibility for ESA accommodation.
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Contact EARC regarding accessibility on EARC webpages.
