Disability Support Request Form
Reporter Information
First Name
Last Name
Phone Number
Ozarks Tech Email Address
Please provide a valid Ozarks Tech Email address
Student Information
Student First Name
Student Last Name
Student ID Number
Requires seven digits
Course Code Information
Department
(i.e. ENG)
Course Number
(i.e. 101)
Course Section
(i.e. W01)
Enter any additional information/comments:
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Contact Information