Public Accommodation Request

* indicates a required field

Student Information

Please enter your information. 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.

Specific Accommodation Information

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.