Fillable Request for Academic Accommodation (Brescia University College)

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Request for Academic Accommodation (Brescia University College)

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The Request for Academic Accommodation (Brescia University College) form is 1 page long and contains:

  • 1 signature
  • 1 check-box
  • 41 other fields

Country of origin: CANADA
File type: PDF

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Request for Academic Accommodation
Student Name
Student Number
Western Email
Are you a Brescia student? Yes No
Documentation must clearly indicate dates of the missed material.
INCOMPLETE FORMS WILL NOT BE PROCESSED
Class Information
Please list only those Professors you wish to be contacted
Course & Course
Number
eg. Psych 3209G
Professor’s
Name
eg. Jane Doe
Professor’s
Email
eg. jdoe@uwo.ca
Course Work
Missed
eg. Essay
Due Date of Missed
Course Work
eg. Nov. 1, 2020
Do you write your exams with Accommodated Exams Service (as per SSD recommendations)?
Yes No
Recommendation for a Special Exam Form Required? Yes No
If yes, student has received Special Exam Form: _______________________________________
Documentation Attached
Medical note: Yes No
If other, please specify: __________________________________________________________
Academic Accommodation is not automatically granted until
all signatures and approvals are received
Student Signature: ______________________________________________________________
Date: _________________________________________________________________________
It is the responsibility of the student to make alternate arrangements with the instructor.
These arrangements must be made as soon as possible.
Once complete, please email to brescia@uwo.ca
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Request for Academic Accommodation (Brescia University College)

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Completed 3 August 2021

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