Alert

Lorem ipsum
Okay
Logo

Academy Course Special Accommodation Request Form

We will make every effort to reasonably accommodate special requests; however, not all requests can be guaranteed. Accommodations depend on the facility where the course is held. Once you submit your request, we will follow up with an update regarding its status and whether we are able to fulfill it. Examples of special requests include: - Access to a private pumping room Use of a refrigerator for breastmilk or dietary-specific meals - Live subtitles or captions for a webinar course - Assistance from the Academy or course host in locating a Medical Model after all other options have been exhausted (https://www.aptapelvichealth.org/medicalmodels).

Select Upcoming Course
If you are requesting for multiple courses, please complete a separate form for each course.
Select Special Accommodation
  • Pumping Room
  • Refrigerator Access
  • Live Captioning for Webinar
  • Need help finding a Medical Model
  • Other
Comments
Please further eleborate on your request.


Assignee
Please select name below. This will help us alert the right staff member.

Do not submit passwords through Airtable forms. Report malicious form