Summary: September 2011 (Page 1 of 2)
Please return this form to:
University ADA Coordinator, Washington Hall/Hotel B-East Range
PO Box 400219 Charlottesville, Virginia 22904
Phone: (434) 924-3200 Fax: (434) 924-1313 Email: firstname.lastname@example.org
For Medical Center Employees
Invitation to Identify Disability Section A
Invitation to Identify Veteran Status Section B
The University of Virginia is an equal employment opportunity/affirmative action employer. Additionally, as a government
contractor, the University is subject to the Vietnam Era Readjustment Assistance Act of 1974, Section 503 of the Rehabilitation
Act of 1973, and the Americans with Disabilities Act Amendments Act of 2008 (ADAAA). Our commitment to equal
opportunity requires that we work to eliminate barriers that may exist for our employees with disabilities. We also have an
affirmative responsibility to employ and advance in employment individuals with disabilities and/or veteran status. Your
participation is essential to our efforts.
We ask for your assistance in meeting our commitment by responding to this form. This form is being sent to all employees. If
you do not have a disability and you are not a veteran, no response is necessary. Please provide information in Section A on
any impairment you may have that qualifies as a disability under the ADAAA, any accommodation you are receiving under the
ADAAA, and/or your need for an accommodation under the ADAAA. Also, please see Section B on how to review and update
your information regarding veteran status.
This information will aid the University in evaluating the needs of our employees and taking measures to meet those needs.