Get the free Notification of Disabilities Referral English

Division of Children and Family Services Early Childhood Education Program Notification of Disabilities Referral Delegate Agency: Site: District of Residence: Date: Name of Child: Address: Home Phone:

How to fill out notification of disabilities referral

How to Fill Out Notification of Disabilities Referral:

1. Begin by accessing the necessary form. You can typically find this form on your employer's intranet or by requesting it from your human resources department.
2. On the top section of the form, fill in your personal information, such as your name, contact details, and employee identification number.
3. Indicate the date on which you are filling out the form.
4. Specify the reason for the referral, which is typically related to a disability or medical condition that may require accommodation or support in the workplace.
5. Provide a detailed description of the disability or medical condition. Be as thorough as possible, using concise and clear language to help others understand the nature of your situation.
6. If applicable, include any supporting documentation or medical reports that further explain the disability or medical condition.
7. Indicate whether you have already sought accommodation or support from your employer or if this is the first request for assistance.
8. If you have already sought accommodation or support, briefly describe the measures that have been taken and their effectiveness.
9. Specify the accommodation or support you are requesting from your employer. Clearly explain how these accommodations or support would enable you to perform your job duties effectively.
10. If you require assistance in completing the form or have any additional comments or concerns, note them in the designated space.
11. Finally, sign and date the form to validate the information provided.

Who Needs Notification of Disabilities Referral:

1. Employees who have a disability or medical condition that may require accommodations or support in the workplace.
2. Individuals who believe they are being discriminated against based on their disability or medical condition and are seeking proper documentation to address the issue.
3. Employees who require adjustments or accommodations to perform their job duties effectively due to a disability or medical condition.

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