Office of Equal Opportunity & Affirmative Action

Pregnancy Modification Request Form for Students

The University of Utah is committed to nondiscrimination, diversity and inclusiveness of all individuals. This form is to be used by University students who are seeking reasonable academic modification due to pregnancy or pregnancy-related conditions

downloadable version of the form is available.

After you complete your submission, you will recieve a response and updates from the Office of Equal Opportunity and Affirmative Action (OEO/AA) as your request is processed by the assigned staff member. If you have questions or concerns, please contact or 801-581-8365
Contact Information

Office of Equal Opportunity & Affirmative Action
Pregnancy Modification Information

(e.g., additional breaks during class, rescheduling tests or exams, excusing absences due to pregnancy or related conditions, larger desk, etc)
Please indicate the date the modification(s) will become medically necessary and the length of the modification(s) if known:

Enter a number for length of time, then select days/weeks/months for dropdown to the right.

Office of Equal Opportunity & Affirmative Action
Additional Information and Supplemental Documents
In some cases, the University of Utah will need to obtain additional information and/or documentation about your condition. This may include documentation from your doctor or other medical provider