Pregnant/Parenting Student Verification

Pregnant/Parenting Student Verification

This form is used to provide notice and/or documentation to the Title IX Coordinator, in accordance with the pregnancy documentation guidelines. Please contact the Title IX staff at titleix@tsu.edu with any questions or concerns. Students are encouraged to submit documentation as soon as reasonably possible and may update the documentation as circumstances change throughout or after childbirth. For more information, visit TSU Title IX Pregnancy & Parenting.

Estimated Date of Delivery*

Name*

TSU Student ID Number*

Phone Number*

Phone

Email Address*

Please select the semester for which the adjustment is needed.*

Select or enter value

Please list the classes (including section number, faculty name, and whether the class is online or in person) for which you will need an accommodation.*

For what date do you need the adjustment to begin? Please select a future date. Adjustments cannot be made retroactively and take a reasonable amount of time to implement.*

Please indicate how long you expect to need the academic adjustment.*

Are you currently receiving any accommodations from the Student Accessibility Services Office (SASO)?*

Yes

Please describe the nature of your situation. This may include concerns related to classes, medical needs affecting your ability to get school work completed, anticipated scheduling conflicts, etc.*

Are you experiencing any complications or medical issues related to the pregnancy? If so, please explain.*

What kind of academic accommodations do you think will be most helpful to you?*

Who is the program director/clinical director/department chair for your Program of Study? (This person(s) may by copied on the letter verifying your anticipated date of delivery or other needs).*