Please use this form to submit an accommodation request. This submission will route directly to our Disability Services Staff and be time stamped upon submission.

We will contact you directly within 5 business days.

Fields marked with an asterisk * are required.

Student Information

The information below pertains to the student requesting or need of support from the Office of Disability Services.

Student Name

* May we leave a message?

You Must Choose Yes or No.

You Must Choose A Program

CNA students: Please signify that you are in the CNA program in the Intake Questions below.

Intake Questions

Qualified individuals are entitled to accommodations under the Americans with Disabilities Act (ADA) regulations. To access services, individuals must initiate this request in writing for specific accommodations/services at least one month prior to entering Southwest Technical College. Accommodations are determined on a case-by-case basis. All information will be considered confidential and only released to appropriate personnel on a need-to-know basis. Accommodations prescribed only apply to Southwest Wisconsin Technical College and may not be valid elsewhere. The individual takes full responsibility for ongoing assistance.

* The following identifies some of the accommodations/services available through the Disability Services Center. Please check those you may need to assist you at Southwest Tech. Please note this is not a complete list of possible accommodations.

You Must Choose A Requested Service.

Please Choose An Option

Supporting Documentation

* How will you provide disability-related documentation that supports the request for accommodation?

Please Choose A Delivery Option

Required

* Disability Services has my permission to collaborate with SWTC staff and faculty for educational purposes.

You Must Choose Yes or No.