|Instructor's Name||Jim Leitzel|
|Instructor's e-mail firstname.lastname@example.org|
|Course Registration Number (CRN)||85571|
|Specify the length of time that the agreement will be in effect:||current quarter|
Section A: Excused Absences/Make-up Participation Points
|Using the Attendance and Flexibility Consideration Rubric, I have determined that:||a student with a disability may miss class for disability-related reasons beyond the number of allowed absences on the syllabus. Additional information is required.|
|The maximum number of excused absences without penalty permitted:||9|
|Additional details or exceptions to allotment: ||I do not track attendance in this course, and student grades are not based on their attendance or participation.|
|Plan for make-up participation points, if applicable (e.g. .submit additional blog posts on Canvas):||N/A|
|Please explain why absences beyond the number allowed in the syllabus is not a reasonable accommodation.|
Section B: Deadline Extensions for Assignments
|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:||students with a disability may have deadline extensions. Additional information is required.|
|Applicable assignments (check all that apply):||homework assignments, papers|
|List any assignments that are not approved for deadline extensions|
Please specify the expectations for deadline extensions.
|Assignment Type(s)||homeworks, policy briefs|
|Timeframe for deadline extension (select one):||The assignment(s) will be due within a certain number of business days of the original due date. Additional information is required.|
|Specify the number of business days: ||5|
|Specify the revised due date:|
|If applicable, please detail the notification plan for requesting assignment extensions.||notice to be given. before class, by email|
|Please explain why deadline extensions beyond the number allowed in the syllabus is not a reasonable accommodation.|
Section C: Make-up Quizzes/Exams
|I have determined that administering a make-up quiz/exam is:||a reasonable accommodation. Additional information required.|
|Timeframe for Make-Up Quizzes/Exams (select one):||The make-up quiz/exam will be administered within a certain number of business days of the original quiz/exam date. Additional information required.|
|Specify the number of business days:||5|
|Specify the date:|
|Proctoring of the make-up quizzes/exams (select one):||I am requesting SDS assistance with proctoring make-up quizzes/exams. SDS will follow up to discuss testing arrangements.|
|Student responsibilities when using these accommodations:|
- To use these accommodations for disability-related reasons only and to maintain prompt and regular communication with the instructor.
- To contact the instructor and SDS if unable to meet the terms of this agreement.
- 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.
- This agreement becomes effective when sent to the student by SDS. The terms of this agreement are not retroactive to previous course requirements.