ADA Accommodation Request

According to the Equal Employment Opportunity Commission, "Title I of the Americans with Disabilities Act of 1990 (ADA) requires an employer to provide reasonable accommodation to qualified individuals with disabilities who are employees or applicants for employment, unless to do so would cause undue hardship. In general, an accommodation is any change in the work environment or in the way things are customarily done that enables an individual with a disability to enjoy equal employment opportunities.

To be eligible for a reasonable accommodation under the ADA, an employee must have an impairment that substantially limits one or more major life activities, or a record of such an impairment.

If you feel you need a reasonable accommodation, please complete the information below and a member of the Human Resources team will contact you within two (2) business days.

Applicant Name *

First Name Last Name

E-mail *

Phone Number *

Area Code Phone Number

Select type

Mobile Home Work

Alternate Phone Number

Area Code Phone Number

Select Type

Mobile Home Work

Best Time to Contact

Morning Afternoon Evening

Name of YMCA *

Current YMCA position

Please specify your current position at the YMCA, if applicable.

Position applying for

Please specify the position you are applying for at the YMCA, if applicable.

*The Genetic Information Nondiscrimination Act of 2008 (GINA) prohibits employers and other entities covered by GINA Title II from requesting or requiring genetic information of an individual or family member of the individual, except as specifically allowed by this law. To comply with this law, we are asking that you not provide any genetic information when responding to this request for medical information. "Genetic information," as defined by GINA, includes an individual's family medical history, the results of an individual's or family member's genetic tests, the fact that an individual or an individual's family member sought or received genetic services, and genetic information of a fetus carried by an individual or an individual's family member or an embryo lawfully held by an individual or family member receiving assistive reproductive services.

Thank you for providing this information!

If you have any questions or if someone has not reached out to you, please contact (713) 659-5566.