Initial Accommodation Request

* indicates a required field

Student Information

Disability Resources provides services and accommodations for students with documented disabilities at Moraine Park Technical College. The information you provide will be used to determine your eligibility. The information you provide is confidential.
Enter your college ID, if you are not enrolled please enter your phone number
Please provide the email address we can use to contact you.
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Specific Accommodation Information

*My diagnosed disability falls into the following categoryRequired
select all the apply
*How does your disability impact you?Required
select all that apply
*What is your preferred campus when meeting with an Accommodation Specialist?Required
Accommodation Specialists can also meet virtually
Have you had previous contact with MPTC Disability Resources?



Upload supporting document(s)
Next Steps:Required

The next step in the Accommodation Process is to schedule an in-person or virtual appointment with the Accommodation Specialist at your preferred campus. Please choose the option that best meets your needs for scheduling an appointment.

Confidentiality Statement

By submitting this form, I acknowledge that:

(1) I have filled out this form with accurate information

(2) This application will not be processed until pertinent documentation of disability has also been provided

(3) The Accommodation Specialist will consider the accommodations as requested on this form

(4) Accommodations, if rendered, may not be the same as those I received in high school or at another institution, and will not apply retroactively

(5) Notification will be sent upon completion of the accommodation determination process

(6) Disability Resources will not disclose confidential information obtained from the discloser to anyone unless required to do so by law or an authorization to release confidential information has been signed.