Attendance Flexibility and Deadline Extensions Accommodation Agreement Form

Attendance Flexibility and Deadline Extension Accommodation Agreement Form

The Attendance Flexibility and Deadline Extension Accommodation Agreement Form is used to document whether and to what extent the access need for flexibility can be accommodated in your course. This form is required as SDS engages in an interactive process to provide appropriate accommodations for students with disabilities. Your participation as the instructor and designer of the course is essential. We highly recommend that you review the Guide to Assessing Accommodation Requests for Attendance Flexibility and Deadline Extensions for Instructors (PDF) in advance of completing this form.
Please complete this form if you have received a Faculty Notification Letter from SDS on behalf of a student who requires flexibility with attendance, extended time for assignments, chronic full flexibility and/or flexibility with participation.

Specify the length of time that the agreement will be in effect: *

Section A: Excused Absences/Make-up Participation Points

Use the Attendance and Flexibility Consideration Rubric to analyze if and to what extent an attendance accommodation can be implemented for each course while maintaining essential course requirements and learning objectives.
Using the Attendance and Flexibility Consideration Rubric, I have determined that: *
Example: standard=3, adjusted=6
Example: lecture absences allowed, absences from discussion section not allowed
Example: student will submit additional blog posts on Canvas

Section B: Deadline Extensions for Assignments

Use the Deadline Extensions Consideration Rubric to analyze if a deadline extension(s) is a reasonable accommodation and for how long an extension is allowable to ensure equitable access to the student while maintaining essential course requirements. Examples of assignments include but are not limited to problem sets, lab reports, papers, and presentations.
Important Notice to Students: The consequences outlined for the class for missing the deadline applies to the adjusted deadlines for the student using this accommodation.
Using the Deadline Extensions Consideration Rubric, I have determined that: *
Applicable assignments (check all that apply):

Please specify the expectations for deadline extensions.

Timeframe for deadline extension (select one):
Example: notice to be given. before class, by email.

Section C: Make-up Quizzes/Exams

Students with conditions that result in unanticipated medical episodes may be unable to attend class or a scheduled exam administration. A student with this accommodation must have the opportunity to take a make-up exam of quiz that is a similar format and difficulty. Please complete the information below outlining your expectations for the student to make-up assessments.
I have determined that administering a make-up quiz/exam is: *
Timeframe for Make-Up Quizzes/Exams (select one):
Proctoring of the make-up quizzes/exams (select one):
Student responsibilities when using these accommodations:

  1. To use these accommodations for disability-related reasons only and to maintain prompt and regular communication with the instructor.
  2. To contact the instructor and SDS if unable to meet the terms of this agreement.
  3. To be responsible for meeting the policies in the course syllabus and the essential requirements of the course, as is required by all other students enrolled in the course.
  4. This agreement becomes effective when sent to the student by SDS. The terms of this agreement are not retroactive to previous course requirements.

This form is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Related Links

Scroll to Top