Please use this form to submit a pregnancy adjustment request. This submission will route directly to our Staff and be time stamped upon submission.

We will contact you directly within 5 business days.

Fields marked with an asterisk * are required.

Student Information

The information below pertains to the student requesting or need of support from the Office of Disability Services.

Student Name

* May we leave a message?

You Must Choose Yes or No.

Intake Questions

Please Choose At Least One Term

Supporting Documentation

* How will you provide pregnancy-related documentation that supports your request?

Please Choose A Delivery Option


* Disability Services has my permission to collaborate with SWTC staff and faculty for educational purposes.

You Must Choose Yes or No.