Title IX Self-Identification Form for Pregnancy

Questions marked with a * are required

Student Pregnancy and Related Conditions Assistance Request Form

Submitting this form allows the Title IX Office to coordinate with you and other university offices to facilitate reasonable adjustments and modifications related to student pregnancy and related conditions status.
Disclosure of pregnancy or related condition status is voluntary and not required, and students are not required to work with Title IX and may instead opt to work directly with their faculty to discuss absences, options for making up missed work, and other reasonable adjustments.
The Title IX Office may request additional documentation if necessary to provide or determine options for reasonable adjustments and modifications.
Submission of this form in no way implies that the requests contained in this form will be approved as submitted.
Reasonable adjustments that would fundamentally alter the academic objectives of a course or program or that would cause an undue hardship on the university may not be granted.
Students who experience a change in their condition or needs should, in addition to speaking to their faculty, inform the Title IX Office as soon as practicable to submit any amended request for needs so the Title IX Office can determine what if any additional assistance is necessary.
Students who experience a temporary or permanent medical condition or disability arising from or exacerbated by pregnancy or pregnancy-related conditions and/or complications and therefore may have needs that may be more appropriately considered through the Office of Disability Services (ODS) may contact ODS.

To proceed, you must enter your initials as verification that you have read and understand the information on this screen.