Modified Absence Policy Planning Form

This form is intended as a guide and a means for documenting discussion around implementation of a student's Attendance/Absence accommodations. For more information on this accommodation, please review the DRC's page on Attendance/Absence Accommodations, or contact the student's Disability Services Specialist.

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Course and Contact Information
Course Name * Required
Instructor Name * Required
Instructor Email Address * Required

A copy of this form will be sent to this email address for your records.
Student Name * Required
Student Email Address * Required

A copy of this form will be sent to this email address for your records.
Who is the student's Disability Services Specialist? * Required
The DSS name can be found at the top of the Letter of Accommodation. A copy of this form will be sent to the student's DSS, and the DSS is available at any time to help facilitate implementation of this plan.
In-Class Participation
The optional questions in this section are designed to help determine whether and to what extent in-class participation is an essential element of this course.
Is there a maximum number of absences allotted in the course syllabus? If so, how many?
Do components of the course rely on live discussion and/or teacher-student or student-student interaction?
Does attendance or participation count toward a student's final grade? If so, what percentage?
Briefly list course components, such as group projects, class trips, or guest lectures, that may be difficult or impossible to make up if a student is absent.
Modified Attendance Plan
After discussing the requirements of the class, student and instructor agree to the following modified attendance plan. Should the student or the instructor need further guidance and any point in the creation or implementation of this plan, please contact the student's Disability Services Specialist.
How many absences are permitted for this student?

This number should reflect the maximum number of classes the student can miss before fundamentally altering essential course requirements/expectations/outcomes, and may be expressed as a percentage of class meetings, or a number of class meetings.
How should the student notify the instructor if they are going to miss a class?

Note: At no time are students required to present documentation to instructors in order to justify a disability-related absence.
How should the student catch up on content missed during an absence?

Options might include attending another lecture/lab session, attending office hours, or obtaining notes from a classmate.
How should assignments due during an absence be turned in, and within what timeframe?

Generally, long term assignments that were assigned prior to absence may still be collected electronically during an absence, but short term assignments may require short deadline extension.
How will the student's grade be impacted should they exceed the number of permitted absences indicated above?
Please list any other attendance related considerations that are specific to this class:

Modified Absence Policy Planning Form

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Course and Contact Information

In-Class Participation

Modified Attendance Plan

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