Public Accommodation Request

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Student Information

Please enter your information. The information you provide is confidential.
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Enter your college ID, if you are not enrolled please enter your phone number
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Please provide the email address we can use to contact you.
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Specific Accommodation Information

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Have you had previous contact with MPTC Disability Resources



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.