Request for Student Religious Accommodation

Request for Student Religious Accommodation

Name*

EID*

Email Address*

Phone Number*

Phone

Is this accommodation request based on a religious belief, practice, or observance?*

Yes

Please provide the name of the Instructor(s), course(s) and course number(s) that you are requesting an accommodation for.*

Please enter the information in the following format: Instructor Name/Course Name/Course Number.

Dates requested*

Please describe the specific accommodation(s) that you are requesting at this time and how it will enable you to meet your religious obligations.*

Please specify if the requested accommodation has already been communicated to the corresponding Instructor(s) and what the outcome of that communication was.*

Verification and Accuracy

I verify that the above information is complete and accurate to the best of my knowledge.*

*Submission of this application does not automatically grant an accommodation.

Please enter your Initials:

Date*

Send me a copy of my responses

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