Applications Application

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Applications Application

Introduction

Type: Pregnancy and Related Conditions Accommodations.

This form is intended to be used to connect students who are experiencing one or more of the following situations with appropriate support and resources:

A student is currently pregnant or expecting a child and will need accommodations due to medical necessity;
A student has recently given birth or had a child during the current semester or within the past 12 weeks;
A student is expecting to adopt a child;
A student has adopted a child during the current semester or within the past 12 weeks;
A student has lost a pregnancy during the current semester or within the past 12 weeks;
A student is undergoing fertility treatments or other medical procedures related to pregnancy;

It is important to note that students of any gender are entitled to protection under Title IX.

Application Information

Start Termrequired field:

Expected Graduation Termrequired field:

Personal Information

First Namerequired field:

Preferred Name, if different than first name:

Middle Name:

Last Namerequired field:

Vandal ID#:

Hint: Enter 9 alpha numeric characters.

Contact Information

Email Addressrequired field:

Primary Phone Number:Specify country code for Primary Phone NumberSpecify Primary Phone Number

List of Questions

Question 1: This request is for:required field

A student who is pregnant

A student who recently gave birth

A student who recently lost a pregnancy

A student who is in the process of adopting a child

A student who recently adopted a child

Other (please explain below)

Additional Comment:

Question 2: Please provide as much information as you are able, including relevant dates or complications.required field

Form Submission

Question?

Center for Disability Access and Resources
Division of Student Affairs
The University of Idaho
Phone: 208.885.6307 | cdar@uidaho.edu | Bruce M. Pitman Center 127
Fax: 208.885.9404
Campus Zip: 4257