Flexibility Accommodation Request Form

"*" indicates required fields

This form is intended only for students registered with NIACC Disability Services (NDS) who require flexibility in course policies related to attendance and course-related due dates where appropriate and reasonable. It is not intended to serve as an attendance or assignment waiver. Students are expected and encouraged to attend class and meet deadlines for coursework, as published in their course syllabi.

To make this accommodation effective, each semester:

Student should review each course syllabus related to attendance, assignment completion/submission, late work, and makeup exams/quizzes.
If additional flexibility is needed from what is stated in the course syllabus, student must submit this Flexibility Accommodation Request Form, attaching the course syllabus.
NDS will consider flexibility accommodations upon notice of the student’s need for the accommodation by reviewing the student request, qualifying documentation, and class syllabi, consulting with both the student and instructor(s), and make the determination if the accommodation(s) for flexibility is/are reasonable based on the individual needs of the student and the design & delivery of the course.
A Flexibility Accommodation Agreement will be provided to the student and instructor for each approved class.

Important Notes (check each after you’ve read them)

A meeting may be requested between the student and NDS at any time during the flexibility accommodation process.

For every disability-related occurrence, students are expected to email faculty using the specified instructions stated in the Flexibility Accommodation Agreement.

The flexibility accommodations are not a blanket reason to miss class or submit late work.

Absences that are not related to the effects of a disability are not included in this accommodation (e.g. absences due to a common illness, personal appointments, childcare, work, etc.) and should be addressed according to the attendance/absence policy stated in the syllabus.

Students are not required to present the faculty with medical documentation verifying the disability-related occurrence.

Flexibility accommodations are not retroactive. Accommodations are effective once the flexibility accommodation agreement has been created/shared for each course.

Course syllabi must be attached to the request form in order for the process to move forward. Contact instructors with any issue in obtaining a syllabus. If you have trouble uploading a syllabus, NDS recommends scheduling an appointment.

Typically, accommodations aim to ensure that all coursework is submitted by the end of the current semester or term. However, we understand that unique circumstances may arise. If this happens, it’s important to contact NDS as soon as possible to discuss individual needs and find the best possible solution before the semester/term ends. If this does not occur, it’s assumed all work will be turned in by the last day of each class.

If you do not understand your rights and responsibilities, the Flexibility Accommodation process, timeline, its potential limitations, or have questions or concerns about this accommodation, contact NDS; DisabilityServices@niacc.edu or 888-466-4222, ext. 4296.

Student and/or instructors who find changes are necessary to the flexibility accommodations that have been agreed upon for any particular semester should contact NDS to request formal changes to the flexibility accommodation agreement.

I acknowledge my understanding of all information above.

Name*

First Last

Email*

Student ID*

Semester of Request

Impact & Variability of your Condition

How do symptoms of your condition manifest, how often do you experience increased severity of your symptoms, and how long does the increased severity of your symptoms last?*

Describe your experience with symptoms and how they may impact your ability to attend class and/or participate in academic work and what are the specific challenges you face with the current attendance and due date policies?*

How often do you anticipate needing to miss class or submit late coursework due to your condition during the semester?*

First: Exploring Alternatives – Are there other ways NIACC can help you stay on track with course material or attend class in place of flexibility accommodations?*

Courses for which you are making this request:

Course 1

Professor’s Name

First Last

Course Prefix, Number and Section:

What is the class’ policies on attendance and late work?

What flexibility accommodations are you requesting for this course?

Course 2

Professor’s Name

First Last

Course Prefix, Number and Section:

What is the class’ policies on attendance and late work?

What flexibility accommodations are you requesting for this course?

Course 3

Professor’s Name

First Last

Course Prefix, Number and Section:

What is the class’ policies on attendance and late work?

What flexibility accommodations are you requesting for this course?

Course 4

Professor’s Name

First Last

Course Prefix, Number and Section:

What is the class’ policies on attendance and late work?

What flexibility accommodations are you requesting for this course?

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Flexibility Accommodation Request Form

Semester of Request

Course 1

Course 2

Course 3

Course 4