Forms
Requesting an Employment Accommodation(s) from the EARC
The following forms are to be used by SJSU employees who:
- Would like to register with the EARC; or
- Is currently registered with the EARC and is requesting modification and/or additional employment accommodations for an existing condition(s).
Note: An employee registered with the EARC has provided the EARC with appropriate documentation that qualifies him/her as an individual with a disability under FEHA and/or ADA, as amended.
Registration Forms
Please complete the forms below to register with the EARC.
- EARC Intake Form [DocuSign]
- To be completed by employee - EARC Verification Form [pdf] - To be completed by treating professional
- ADA/FEHA COVID-19 Disability Accommodation Certification Form [pdf] - To be completed by treating professional for COVID related accommodation requests
- EARC Emotional Support Animal (ESA) Verification Form [pdf] - To be completed by appropriate professional
Contact EARC regarding accessibility on EARC webpages.
