Southwest Tech accommodations request form

Accommodation Request

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

* First Name:

* Last Name:

Charger ID#:

* Email Address

* Phone Number:

* May we leave a message?

You Must Choose Yes or No.

High School Attended/Attending:

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.

For what reason is the student requesting/in need of an accommodation?

* If other, please explain.

* When would you like to begin using accommodations?

Please Choose An Option

* You will be scheduled for a meeting with a Student Disability Specialist based on your class schedule. If you have a preferred meeting time or window or special instructions, please provide that information below; we will try to meet your request if possible.

Supporting Documentation

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

Please Choose A Delivery Option

Upload electronically (see below)
Mail to Disability Services, Southwest Tech, 1800 Bronson Boulevard, Fennimore, WI 53809
Hand deliver to Disability Services, Building 300, Room 314, Southwest Tech
Email (provided in confirmation email)
Fax to 608-822-2673

Required

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

You Must Choose Yes or No.

*The undersigned agrees to conduct this transaction electronically. The undersigned understands that their consent to conduct this electronically is not consent to conduct any future transaction electronically.

Accommodation Request

Uploaded Documents