Fillable SEATTLE UNIVERSITY STUDENT ACADEMIC RELIGIOUS ACCOMMODATIONS REQUEST FORM (Seattle University)

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SEATTLE UNIVERSITY STUDENT ACADEMIC RELIGIOUS ACCOMMODATIONS REQUEST FORM (Seattle University)

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SEATTLE UNIVERSITY
STUDENT ACADEMIC RELIGIOUS ACCOMMODATIONS REQUEST FORM
July 1, 2019
Verification
I verify that my religious beliefs are sincerely held and that I am motivated by religious purpose to request
this accommodation to observe my religious holidays. I understand that in determining whether to grant
this request the University may inquire as to the sincerity of my beliefs as well as the purpose for my
request. The University may also be limited in its ability to provide an accommodation that presents an
undue hardship to the University or a fundamental alternation of the nature or operation of the academic
program or course.
Date
Signature
Student Information
Student’s Name:______________________________________________________________________________
E-mail Address:_______________________________ Telephone Number: __________________________
Class Information
Course Title, Number and Section Student is Seeking Accommodation(s):__________________________________
___________________________________________________________________________________________
Faculty Member’s Name:________________________________________________________________________
School/College:
☐
A&S
☐
Nursing
☐
Albers
☐
Science and Engineering
☐
Education
☐
STM
☐
Law
☐
NCS
Requested Accommodation(s)
A. Identify the examination schedule or other academic activities which you are seeking religious accommodation(s).
____________________________________________________________________________________________
B. Explain how the examination schedule or other academic activities conflicts with the observance of your religious
holidays.
____________________________________________________________________________________________
C. Identify the accommodation(s) or modification(s) you are requesting.
____________________________________________________________________________________________
D. List any other accommodation(s) that would eliminate the conflict.
____________________________________________________________________________________________
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SEATTLE UNIVERSITY
STUDENT ACADEMIC RELIGIOUS ACCOMMODATIONS REQUEST FORM
July 1, 2019
For Department Use Only
DECISION
Request Approved:
Yes
No
Identify accommodation(s) provided:
____________________________________________________________________________________________
____________________________________________________________________________________________
If denied, state the reason (e.g., fundamental alteration, undue hardship).
____________________________________________________________________________________________
____________________________________________________________________________________________
Date
Signature
Name
Title
APPEAL PROCEDURE
A student may appeal the decision by submitting the appeal in writing to the Office of the Dean of
the respective school or college of the class the student is seeking accommodations no later than
five (5) calendars after the date of the decision. The decision of the Dean or designee will be final.
ADDITIONAL INFORMATION
Students
•
Questions about the interpretation or application of the Policy on Religious Accommodations on
Students should be raised with the Office of Institutional Equity. Please contact OIE at (206)
•
Seattle University Policy on Religious Accommodations for
https://www.seattleu.edu/media/policies/Policy-on-Religious-Accommodations-for-
Students---FINAL.PDF
296-2824 or oie@seattleu.edu for assistance.
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SEATTLE UNIVERSITY STUDENT ACADEMIC RELIGIOUS ACCOMMODATIONS REQUEST FORM (Seattle University)

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Completed 26 August 2020

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