|Instructor's Name||Test Test|
|Instructor's e-mail firstname.lastname@example.org|
|Course Registration Number (CRN)||12345|
|Specify the length of time that the agreement will be in effect:||current academic year|
Section A: Excused Absences/Make-up Participation Points
|Using the Attendance and Flexibility Consideration Rubric, I have determined that:||excused absences/make-up participation points are not applicable in the course.|
|The maximum number of excused absences without penalty permitted:|
|Additional details or exceptions to allotment: |
|Plan for make-up participation points, if applicable (e.g. .submit additional blog posts on Canvas):|
|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:||deadline extensions are not applicable in the course|
|Applicable assignments (check all that apply):|
|List any assignments that are not approved for deadline extensions|
|If applicable, please detail the notification plan for requesting assignment extensions.|
|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:||10|
|Specify the date:|
|Proctoring of the make-up quizzes/exams (select one):||The instructor or TA will proctor.|
|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.