Application for Disability Support Services and Title IX

Student Information

Please enter your information

First Name

Last Name

Middle Initial

Preferred Name

Student ID

If a current Gateway student, please enter your ID number.
If a prospective student, please enter in "InitialsSemesterStart" (example of Jane Doe starting in Fall 2021: JDFall2021).

Email

If a current Gateway student, please use your college issued email address.
If a prospective student, please use your personal email address.

Phone number where you can be reached

What is your preferred contact method?

Choose all that apply

Street Address

City, State & Zip Code

When do you plan to start at Gateway Technical College?

Are you a veteran or veteran dependent?

I am requesting accommodations for

If 'Other" is chosen, please specify.

If a current High School Student, please provide your High School Special Education case manager and their contact information

Name of High School

Case Manager Name and Title

Case Manager Email

Case Manager Phone

Specific Accommodation Information

Describe how your disability or pregnancy impacts your learning.

Accommodations and/or support services that have helped you overcome barriers.

Upload supporting document(s)

Application for Disability Support Services and Title IX - Pregnant and Parenting

Student Information

If a current High School Student, please provide your High School Special Education case manager and their contact information

Specific Accommodation Information

Document Information