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Pregnant/Parenting Student Resources & Support Request Form

The U.S. Department of Education's regulation implementing Title IX specifically prohibits discrimination against a student based on pregnancy, childbirth, false pregnancy, termination of pregnancy, or recovery from any of these conditions. The Title IX regulation also prohibits a school from applying any rule related to a student's parental, family, or marital status that treats students differently based on their sex.

For further information or guidance regarding Title IX for pregnant and parenting students, please contact, Compliance Coordinator at 254-968-9754.

Background Information

Your full name:

Self/Referral:

Learn more

Please indicate as to whether you are completing this form for yourself or referring a student.

Your phone number:

Your email address:

Email address must be of a valid format.

Your physical address:

Time of incident:

Specific location:

Student Information

Involved party 1

Student Name

ID Number

Phone number

Email address

On-Campus/Off-Campus

Questions

Please complete the following questions.

Please select from the following options.(Required)

Pregnant Parenting Both (currently have children and pregnant)

This field is required.

Are you currently, or in the past have you, received accommodations through Title IX for pregnancy or parenting?(Required)

Yes No

This field is required.

Are you requesting housing accommodations?(Required)

Yes No

This field is required.

Are you requesting academic accommodations?(Required)

Yes No

This field is required.

Semester you are requesting accommodations to begin (ex. Fall 2020):(Required) This field is required.

What additional accommodations or resources do you feel would assist you?(Required) This field is required.

Degree Information:(Required)

Undergraduate Graduate

This field is required.

Campus Designation:(Required)

Stephenville Waco Ft. Worth Midlothian Global

This field is required.

Major (noted in DegreeWorks):(Required) This field is required.

Supporting Documentation

Please attach any documentation that you would like reviewed. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission

Email me a copy of this report