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Student Pregnancy & Parenting Accommodation Request


Madison College is committed to the protection and equal treatment of pregnant students, students with pregnancy-related conditions, and students who are new parents in all aspects of an educational program. This includes Madison College-sponsored extracurricular activities and internships, athletics, financial aid and scholarships, career counseling/advising, and lab and clinical work.

Title IX of the Education Amendments of 1972 states that no school that receives federal funding can discriminate against someone because of their sex, which includes discrimination due to pregnancy, giving birth, abortion, recovery from childbirth or any related conditions.

Pregnant students and those with related medical conditions may also be eligible for disability protections and services under the Americans with Disabilities Act (ADA), depending upon their condition. Although pregnancy is NOT a disability under the law, the medical conditions that may affect a pregnant student may qualify as disabling conditions. Disability Resource Services (DRS) works in partnership with students, faculty and staff to support pregnant and parenting students.

PLEASE NOTE: This form is for students requesting an accommodation or academic adjustment based on pregnancy, childbirth or a related medical condition. Employees in need of a pregnancy-related accommodation should consult the Employee Handbook and contact their Human Resources Business Partner.

Concerns related to denial of accommodations or refusal of support should be referred to the Title IX Coordinator and can be reported using the Equal Opportunity Violation Reporting Form.

Reporter Information

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Student Information

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Accommodation Information

Please Identify the accommodation(s) you are requesting (choose all that apply). NOTE: A Disability Resource Services Specialist will work with you and the Title IX Coordinator to determine the reasonable accommodations for which you qualify. Your selection here will provide the DRS Specialist with a basic understanding of your desired need.(Required)
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Supporting Documentation

To help expedite the process please upload a doctor's note with the applicable information (i.e., due date, delivery date, diagnoses, complications, or parental support needed for the child / pregnancy). The note must be on letterhead, dated and signed from a licensed professional. ** Faculty and staff ** DO NOT request or submit documentation on behalf of the student. Please refer the student to Disability Resource Services or the Dean of Students Office. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

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