Title IX: Pregnancy & Parenting Modifications Request Form

Miles College is dedicated to creating an environment that is welcoming, accessible, safe, and inclusive for pregnant and parenting students.

Students requesting Title IX modifications and services are required to provide information in support of their request.  For some modifications, students may be required to provide official documentation from licensed medical professionals.

Supporting documentation should include recommended modifications, beginning and end dates for the modifications, and the name of the professional completing the evaluation, including credentials and contact information.

Requests will be processed as soon as possible, and a member of the Office of Disability Services will be in contact within two days of the report submission.

Student Name
Please provide the specific modifications that are being requested. Select all that apply:
Please indicate the type of modifications requested.