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Pregnancy Accommodations Request


The purpose of this form is to assist the University in determining whether, or to what extent, an academic accommodation related to pregnancy or parenting can be granted. Please provide the following information to request academic accommodations. If you are an employee at UTRGV and require workplace accommodations related to pregnancy or parenting, contact Human Resources.

Examples of possible reasonable academic accommodations (when deemed medically necessary) are:

  • A larger desk
  • Excused absences due to pregnancy related condition
  • Breaks during class, as needed
  • Submitting work after a deadline missed due to pregnancy or childbirth
  • Providing alternatives to make up work

 

General information

 
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Pregnant student who is requesting accommodations

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Involved party 1

Pregnant student who is requesting accommodations

To best meet your needs, please answer all of the questions in this section.

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Select Gender(Required)
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Student Classification(Required)
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Are you currently enrolled at UTRGV?(Required)
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Consent to Release Student Information: The Family Rights and Privacy Act (FERPA) protects the privacy of your education records. Student Accessibility Services (SAS) takes all appropriate steps to comply with FERPA. With limited exceptions, SAS needs your consent before it can release information from your student education records. One notable exception is that the law allows SAS to disclose information from your education records, without consent, to school officials with legitimate educational interests. This consent does not cover records received from the UTRGV Counseling Center. Those records must be requested directly from that office. By checking the box below, you hereby grant consent to SAS to provide information from your SAS records. These records may be released orally or in the form of copies of written records, as preferred by the requestor. I have a right to inspect any written records release pursuant to the Consent (except for parent's financial records and certain letters of recommendation for which the student waived inspection rights). I may revoke this Consent by written request.(Required)
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To whom may the SAS office release your records?(Required)
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The type of information that can be released is as follows (check all that apply):(Required)
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Please select your preferred method of contact (be sure to have included them in the corresponding fields above)(Required)
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Supporting Documentation (Required)

As per UTRGV policy ADM 03-200, documentation is required within 30 days of this request, If documentation is not received the request for accommodation will be cancelled, although you may submit a new request with the appropriate documentation. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission