Persons With Disabilities Registration Form

The College is committed to developing and implementing procedures to assist persons with disabilities during an emergency. In that effort, we provide an opportunity for faculty and staff to inform us regarding their special needs in the event of a situation requiring evacuation. If you are an individual who may need special assistance, please complete the information below. This information will be maintained in a confidential manner and shared only with those involved in emergency response.

Name

Title

Unit / Department

Office Location

Office Extension

Cell Phone

E-mail Address

Work Schedule

Monday

Tuesday

Wednesday

Thursday

Friday

Nature of Disability

Special Assistance Required

Security Check

It is recommended that you carry with you at all times any special instructions regarding assistance that may be required during an evacuation. We encourage you to update this information regularly, especially with regard to changes to your schedule. The information collected with this online form is secure.

For questions about this, please contact Gina Meyer-Costa in the Department of Human Resources at extension 7531 or e-mail gmayerco@ramapo.edu.