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Protocol for Short-Term Academic Consideration

for Students in the Faculty of Arts and Science

November 2017

Table of Contents

Overview .................................................................................................................................................................................. 3

Academic Consideration vs. Academic Accommodation ........................................................................ 3

Background: Guiding Principles, Definitions, and Exclusions ................................................................. 4

Procedures and Steps for Requests for Academic Consideration for Students/Delegates and Instructors ..................................................................................................................................................................... 6

1. Request for Academic Consideration using the Self Declaration for Brief Absence form (up to 48 hours) .............................................................................................................................................................. 62. Request for Academic Consideration for Short-Term Extenuating Circumstances form (more than 48 hours, up to 3 months) ............................................................................................................. 83. Request for Academic Consideration for Excused Absence for Significant Event ................ 10

Information for Students/Delegates ...................................................................................................................... 12

Information for Instructors............................................................................................................................................ 13

Information for Undergraduate Chairs .................................................................................................................. 15

Information for Administrative Staff in other Campus Units ................................................................... 15

Information for Faculty Office Staff, Academic Counsellors .................................................................... 15

Resources ................................................................................................................................................................................ 17

Contacts ................................................................................................................................................................................... 17

Forms ......................................................................................................................................................................................... 18

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OverviewThis protocol is intended to guide students admitted to the Faculty of Arts and Science, instructors, Departmental and Faculty Office staff in situations where extenuating circumstances are interfering with a student’s ability to meet academic requirements related to a course(s) for a short period of time, not to exceed 3 months.

Academic Consideration vs. Academic AccommodationThe chart below provides a summary of the difference between academic consideration vs. academic accommodation. The chart includes information about the relevant Queen’s University Senate policies, the objective, definition and examples of what constitutes academic consideration vs. academic accommodation, the types of conditions that may fall into each category, and who at the University authorizes the arrangements for academic consideration vs. academic accommodation.

Academic Consideration Academic AccommodationQueen’s University Senate Policy

Academic Considerations for Students in Extenuating Circumstances (April 2017)

Academic Accommodations for Students with Disabilities (November 2016)

Objective To provide consistent and fair academic considerations to students for a range of extenuating personal circumstances.

To provide appropriate academic accommodations for students with disabilities as part of the University’s commitment to accessibility and equity.

Definition An action or actions taken by an instructor or Faculty Office in response to a student with an extenuating circumstance.

Examples of academic consideration include:• Excused absence, deferral, extension, modified schedule for assignments, projects, labs, or placements, alternate assignment, re-weighting of term marks, permission for an incomplete grade, or course withdrawal without penalty.

Any adaptation that reduces or eliminates barri-ers to participation, which arise when a student with a disability interacts with the academic environment.

Examples of academic accommodation include: • Extra time, different location, use of computer,

adaptive technology, note-taking, alternate format (e.g., receiving textbooks in audio and/or electronic format), extensions.

Conditions Extenuating circumstance beyond the student’s control, not to exceed 3-months.

Examples of conditions include:• Short-term physical or mental illness (e.g., stomach flu, mononucleosis, pneumonia, short-term anxiety or depression)• Serious injury (e.g., concussion or broken bones)

Chronic or ongoing physical health or mental health condition, or a learning disability.

Examples of conditions include: • Long-term physical or mental illness (e.g., hearing, visual, or mobility impairments, diabetes, cancer, autism spectrum disorder, ADHD/ADD, OCD, schizophrenia, eating disorders, anxiety, depression, etc.)

Academic Consideration Academic AccommodationConditions • Required treatment (e.g., surgery or

medication side effects)• Serious injury or illness of significant other (e.g., car accident)• Bereavement• Traumatic event (e.g., divorce)• Officially representing the University in a sanctioned event

• Learning disability (e.g., dyslexia, dyscalculia, dysgraphia, dyspraxia, auditory or visual processing disorders, etc.)

Responsibility for Authorizing Arrangements

The Faculty Office verifies documentation. Instructor works with student to determine and implement reasonable academic consideration.

Queen’s Student Accessibility Services (QSAS) determines accommodation and provides Letter of Accommodation for instructors to implement.

Students, delegates, instructors and administrators who are unsure if the situation requires an academic consideration or an academic accommodation may contact either the Academic Accommodation Counsellor in the Faculty of Arts and Science (613-533-6000, ext. 75413 or asc.accommodations@queensu.ca) OR Tess Grant, Occupational Therapist at Student Wellness Services (613-533-6000, ext. 75842 or tess.grant@queensu.ca).

Background: Guiding Principles, Definitions, and ExclusionsAs noted in the chart above, the Senate Policy on Academic Consideration for Students in Extenuating Circumstances was approved in April 2017. The Faculty of Arts and Science has developed this protocol to provide a consistent and equitable approach in dealing with requests for academic consideration from students facing extenuating circumstances. Academic consideration does not guarantee a particular level of achievement in a course(s). The following guiding principles, definitions, and exclusions are excerpted from the aforementioned policy and corresponding procedures, but have been adapted for use by Faculty of Arts and Science students, staff and faculty members.

Guiding principles:

• Good faith is a general presumption that all involved are acting with honest and sincere intentions.

• Need-to-know basis means that privacy and confidentiality will be protected and maintained throughout this process to the extent possible. Information may be shared among university personal (e.g., Faculty Office, instructors, Exams Office, Student Wellness Services, etc.) on a need-to-know basis for the purpose of arranging academic consideration. Confidentiality cannot be maintained where there is reason to believe that an individual may be at risk of harming themselves or others.

• Academic integrity provides the foundation for learning, teaching, research and service at Queen’s University. Any behaviour that compromises the values of honesty, trust, fairness, respect and responsibility is considered a departure from academic integrity and may be subject to remedies and sanctions as established by the Faculty of Arts and Science. Providing any false or misleading information, or using the forms contained in the Procedures for Academic Consideration for Students in Extenuating Circumstances to delay or avoid fulfilling academic requirements constitutes a departure from academic integrity, and will be investigated. See the Faculty of Arts and Science website for additional information on Academic Integrity at: www.quartsci.com/academicintegrity

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Definitions:

• Extenuating circumstances refer to a personal circumstance beyond the student’s control that had a direct and substantial impact on the student’s ability to meet essential academic requirements or standards in a course(s).

• Extenuating circumstances include but are not limited to a sudden or acute physical or mental illness, serious injury to self or significant others, bereavement, a traumatic event, or other serious personal/ family crisis. This may include extenuating circumstances that last for a period of a) up to 48 hours, or b) more than 48 hours and up to 3 months.

• Extenuating circumstances may also include officially representing the University at a sanctioned event (e.g., Queen’s varsity teams participating in a provincial, national, or international competition where student participation is essential to the success of the team). This may also be through an invitation to share an exceptional talent or ability at a non-University event on a national or international stage (e.g., musical or artistic performance for the Prime Minister, singing at the opening of the PanAm Games, Olympic qualifier, etc.).

• Academic consideration refers to an action or actions taken by an instructor or the Faculty Office, in response to a student with an extenuating circumstance. Academic consideration includes but is not limited to: an excused absence, a deferral, an extension, a modified schedule for assignments, projects, labs, or placements, an alternative assignment, a re-weighting of term marks, permission for an incomplete grade, course withdrawal without penalty, or other consideration deemed appropriate by the Faculty Office. Instructors can refer to Information for Instructors – Arrangements that can be authorized by an Instructor, p. 13. Students receiving academic consideration must continue to meet all essential academic requirements and standards of the course.

• Essential academic requirements and standards refer to the knowledge and/or skill which must be acquired and/or demonstrated, for a student to successfully meet the learning outcomes of a course or academic work.

Exclusions that are not covered by this protocol:

• Students seeking academic accommodation related to a chronic or ongoing physical or mental health condition or an existing disability should refer to the existing Policy on Academic Accommodations for Students with Disabilities and contact Queen’s Student Accessibility Services (QSAS): 613-533-6467 or accessibility.services@queensu.ca

• Students that are unable to meet academic requirements due to experiencing high levels of academic or exam-related stress should seek out supports and services from Student Wellness Services and contact Tess Grant, Occupational Therapist 613-533-6000, ext. 75842 or tess.grant@queensu.ca

• Students with a personal or family event to attend (e.g., vacations, weddings), transportation or technological difficulty, or other competing commitments should know that these situations are not considered extenuating circumstances under the Senate Policy on Academic Consideration for Students in Extenuating Circumstances and are not generally supported by the Faculty Office. In these cases, students should consult directly with their instructors who have the discretion to approve or deny these requests.

Procedures and Steps for Requests for Academic Consideration for Students/Delegates and InstructorsStudents who experience extenuating circumstances that affect their ability to complete one or more of the academic requirements of one or more courses may request academic consideration. This applies to students enrolled in both on-campus and online courses. There are separate procedures to follow, depending whether the extenuating circumstances last for a period of a) up to 48 hours, b) more than 48 hours and up to 3 months, or relate to c) a sanctioned event.

Students are expected to request academic consideration as soon as the need for this consideration is apparent. While the course is in progress, requests for retroactive academic consideration are considered by the instructor, who may wish to consult with the Faculty Office. If the course has ended, requests for retroactive academic consideration should be made by submitting an appeal to the Associate Dean (Studies) (see Information for Instructors – Arrangements that can be authorized by the Faculty Office through an appeal to the Associate Dean (Studies), p. 14). Appeals related to academic consideration should follow current Faculty Office appeals process. Students may contact an Academic Counsellor or the Academic Accommodation Counsellor in the Faculty Office for additional details related to appeals (see Contacts, p. 17 for information on how to book an appointment).

1. Request for Academic Consideration using the Self-Declaration for Brief Absence Form (up to 48 hours)When this form should be used:This form should be used when a student is requesting academic consideration for a period of up to 48 hours due to experiencing an unexpected illness (e.g., stomach flu) or distressing event (e.g., family member in a serious car accident) that has led to physical or psychological impairment of sufficient severity that the student feels they are temporarily unable to meet academic requirements. This form should be used in situations where the student expects to return to full academic functioning within 48 hours.

The University does not require verification documentation from a health care professional (on-campus or hospital or community-based) in these circumstances.

Type of Request Examples of Extenuating Circumstances VerificationBrief Absence (up to 48 hours)

• Brief illness (e.g., stomach flu)• Family member in serious car accident

• Self-declaration

Short-term Extenuating Circumstances (more than 48 hours, up to 3 months)

• Short-term physical or mental illness (e.g., mononucleosis, pneumonia, short-term anxiety or depression)• Serious injury (e.g., concussion or broken bones)• Required treatment (e.g., surgery or medical side effects)• Serious injury or illness of significant other• Bereavement• Traumatic event

• Health care provider• Obituary• Accident report• Police report• Court order• Letter from professional

Significant Event • University sanctioned event at the provincial, national, or international level

• Atletics OR Student Affairs

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What Students need to do:

1. As soon as the need is apparent (and no later than 24 hours after the end of my brief absence), log into the Academic Consideration Request Portal (ACRP) using your NetID and password. You will need to complete and

submit a Self-Declaration of Brief Absence form, indicating each course where you will miss anacademic requirement during the 48-hour period.

Note: The course syllabus should identify what email address should be used (i.e. instructor, coursecoordinator, etc.).Note: Delegates submitting a Self-Declaration of Brief Absence form on behalf of a studentshould complete the paper form and submit to the Faculty Office by fax: 613-533-2467 or in-person at:

Dunning Hall, First Floor, 94 University Avenue, Kingston, ON Canada, K7L 3N6. Office hours: Monday to Friday8:30am to 4:30pm (closed from 12:00pm to 1:00pm).

2. Your instructor(s) will receive an email notifying them of your request for academic consideration.

3. As soon as possible, you will need to follow up with your instructor(s) either by email or in-person to discusshow you will be making up the missed academic requirements.

4. Complete and submit academic work as agreed upon with your instructor(s).

5. In cases where you anticipate needing an additional day or two beyond the 48 hours, contact your instructor,who has discretion to consider the circumstances and extend academic consideration for brief absencesbeyond 48 hours if they deem it appropriate. If you anticipate you will need academic considerationfor a longer period of time or if your instructor does not agree to extend the brief absence, you willneed to complete and submit a Request for Academic Consideration for Extenuating Circumstancesand applicable Verification forms.

6. If you require assistance at any point in this process, contact the Faculty Office and ask to speak with anAcademic Counsellor.

What Instructors need to do:

1. You will receive an email from the Faculty Office notifying you of the student’s request for academicconsideration.Note: Accept Self-Declaration of Brief Absence forms submitted to the Faculty Office as officialdocumentation. The University does not require verification documentation from a health care professional inthese circumstances.Note: Ensure TAs and others working with students are aware of the Policy and Protocol so that they areprepared to respond to students who have questions. For example, if a TA receives documentation or emailsfrom a student requesting academic consideration, instruct them to advise the student to submit requestsdirectly through the Academic Consideration Request Portal (ACRP).

2. Recognize the University’s ‘good faith’ approach and respond with empathy.

3. Maintain the student’s privacy and confidentiality. Share information only on a need-to-know basis withUniversity personnel (e.g., Faculty Office, instructors, Exams Office, Student Wellness Services, etc.) who requireinformation in the context of the case and for the purpose of arranging academic consideration.Confidentiality cannot be maintained where there is reason to believe that an individual may be at riskof harming themselves or others.

4. As soon as possible, the student will contact you either by email or in-person to discuss the academicconsideration request.

5. Assess missed academic work and provide reasonable academic consideration, while maintaining essentialacademic requirements and standards. Refer to Information for Instructors – Arrangements that can be

authorized by an Instructor, p. 13. Students receiving academic consideration must still meet the learningoutcomes for the course.

6. In cases where the student will need an additional day or two beyond 48 hours, you have the discretion to consider the circumstances and extend academic consideration beyond 48 hours if you deem it appropriate. If you anticipate the student will need consideration for a longer period of time, or if you are unable to extend the brief absence, the student will need to complete and submit a Request for Academic Consideration for Short-Term Extenuating Circumstances and applicable Verification forms. 7. Keep a written record of interactions with the student, the outcome, and action taken to support the student, including only personal details of the student’s extenuating circumstances that are essential to the context. Paper and electronic records should be securely stored and confidentially destroyed as per the University’s records schedule.

8. If the situation is particularly complex, or there is a reason you cannot provide academic consideration for a brief absence, or there are repeated requests for academic consideration, refer the student to the Academic Accommodation Counsellor in the Faculty Office.

What the Faculty Office will do:

1. The Faculty Office will recognize the University’s ‘good faith’ approach and respond with empathy.

2. The Faculty Office will maintain the student’s privacy and confidentiality and share information only on a need-to-know basis with University personnel (e.g., Faculty Office, instructors, Exams Office, Student Wellness Services, etc.) who require information in the context of the case and for the purpose of arranging academic consideration. Confidentiality cannot be maintained where there is reason to believe that an individual may be at risk of harming themselves or others.

3. The Faculty Office will refer students to supports and services as appropriate.

4. The Faculty Office will oversee the tracking of requests/forms, copies of which will be kept in the student file.

5. In cases where repeated requests have been made using the Self-Declaration of Brief Absence form, the Faculty Office will work with the student to ensure they have adequate support for their health and wellness needs, and with instructors to assess the feasibility of meeting repeated requests on a case-by- case basis.

2. Request for Academic Consideration for Short-Term Extenuating Circumstances (more than 48 hours, up to 3 months)When this form should be used:This form should be used when students are requesting academic consideration because they are experiencing extenuating circumstances for more than 48 hours and up to 3 months due to a physical or mental impairment, which results in a reduced ability to meet academic requirements. Extenuating circumstances could include an extended unanticipated illness (e.g., mononucleosis, pneumonia), a serious injury (e.g., concussion or broken bones), a required treatment (e.g., surgical procedure, significant side effects of new medication), serious injury or illness of a significant other, bereavement (e.g., loss of family member), traumatic event, or other significant personal crisis. This form should be used in situations where the student expects to return to full academic functioning within the next 3 months.

The University requires verification documentation from a health care professional in these circumstances (on-campus or hospital- or community-based).

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What Students need to do:

1. As soon as the need is apparent, log into the Academic Consideration Request Portal (ACRP) using your NetID and password. You will need to complete and submit the following forms: a. Request for Academic Consideration for Extenuating Circumstances form; and b. Verification documentation, which may include the Verification of Personal Health Condition form (e.g., physical or mental health), a Verification of Confidential Extenuating Circumstances form, or other documentation (e.g., obituary, police report or accident report, court order, etc.). You are not required to disclose specific details of your personal circumstances to your instructors; however, the Faculty Office may require documentation that verifies the timeline of the extenuating circumstance and your inability or reduced capacity to complete academic work. Note: Additional documentation or details should not be requested from you by an instructor in cases where a Verification of Confidential Extenuating Circumstances form has been submitted.

Note: Delegates submitting a Request for Academic Consideration for Extenuating Circumstances form and Verification Documentation on behalf of a student should complete the paper forms and submit them to the Faculty Office by fax: 613-533-2467 or in-person at: Dunning Hall, First Floor, 94 University Avenue, Kingston, ON Canada, K7L 3N6. Office hours: Monday to Friday 8:30am to 4:30pm (closed from 12:00pm to 1:00pm). 2. Once the request is received, the Academic Accommodation Counsellor will review and verify supporting documentation and then either email you and your instructor(s) to indicate that your documentation has been verified, or email you to request additional documentation if required.

3. Your instructor(s) will receive an email notifying them of your request for academic consideration.

4. As soon as possible, you will need to follow up with your instructor(s) either by email or in-person to discuss your academic consideration request.

5. Complete and submit academic work as agreed upon with your instructor(s).

6. Update the Academic Accommodation Counsellor regarding your recovery and academic progress as appropriate.

7. If it becomes apparent that a full recovery will not take place within 3 months and that ongoing academic support may be required, you should contact Queen’s Student Accessibility Services (QSAS) to register and request ongoing academic accommodations: 613-533-6467 or accessibility.services@queensu.ca 8. If you require assistance at any point in this process, contact the Faculty Office and ask to speak with an Academic Counsellor.

What Instructors need to do:

1. You will receive an email from the Faculty Office notifying you of the student’s request for academic consideration. Note: All requests and supporting documentation for academic consideration for extenuating circumstances for more than 48 hours and up to 3 months, must be reviewed and verified by the Academic Accommodation Counsellor in the Faculty of Arts and Science. Note: Ensure TAs and others working with students are aware of the Policy and Protocol so that they are prepared to respond to students who have questions. For example, if a TA receives documentation or emails from a student requesting academic consideration, please instruct them to advise the student to submit a request directly through the Academic Consideration Request Portal (ACRP).

2. Recognize the University’s ‘good-faith’ approach and respond with empathy.

3. Maintain the student’s privacy and confidentiality. Share information only on a need-to-know basis with University personnel (e.g., Faculty Office, instructors, Exams Office, Student Wellness Services, etc.) who require information in the context of the case and for the purpose of arranging academic consideration. Confidentiality cannot be maintained where there is reason to believe that an individual may be at risk of harming themselves or others.

4. As soon as possible, the student will contact you either by email or in-person to discuss the academic consideration request.

5. Assess missed academic work and provide reasonable academic consideration, while maintaining essential academic requirements and standards. Refer to Information for Instructors – Arrangements that can be authorized by an Instructor, p. 13. Students receiving academic consideration must still meet the learning outcomes for the course.

6. Keep a written record of interactions with the student, the outcome, and action taken to support the student, including only personal details of the student’s extenuating circumstances that are essential to the context. Paper and electronic records should be securely stored and confidentially destroyed as per the University’s records schedule.

7. If it becomes apparent that a student will not have a full recovery within 3 months and that ongoing academic support may be required, direct the student to contact Queen’s Student Accessibility Services (QSAS) to register and request ongoing academic accommodation: 613-533-6467 or accessibility.services@queensu.ca

8. If the situation is particularly complex, or there is a reason that you cannot provide academic considerations for a lengthy absence, or there are repeated requests for academic consideration, refer the student to the Academic Accommodation Counsellor in the Faculty Office.

What the Faculty Office will do:

1. The Faculty Office will recognize the University’s ‘good faith’ approach and respond with empathy.

2. The Faculty Office will maintain the student’s privacy and confidentiality and share information only on a need-to-know basis with University personnel (e.g., Faculty Office, instructors, Exams Office, Student Wellness Services, etc.) who require information in the context of the case and for the purpose of arranging academic consideration. Confidentiality cannot be maintained where there is reason to believe that an individual may be at risk of harming themselves or others. 3. The Faculty Office will refer students to supports and services as appropriate.

4. The Faculty Office will review and verify supporting documentation. 5. The Faculty Office will oversee the tracking of requests/forms will be kept in the student file.

6. The Faculty Office will work with students and instructors in cases where there are challenges determining reasonable academic consideration.

3. Request for Academic Consideration for Excused Absence for Significant EventWhen this form should be used:This form should be used when students are requesting academic consideration because they are representing the University through participation in a University-sanctioned varsity athletic event, or as a distinguished guest at a sanctioned non-university event. This participation may require the student to be absent from campus for a short period of time and may limit the student’s ability to meet academic requirements. This applies to:

• A Queen’s University varsity athletics team participating in a significant event (e.g., provincial, national, or international championship) where student participation is essential to the success of the team; or

• A student who is invited to share an exceptional talent or ability at a non-University event on a national or international stage (e.g., musical or artistic performance for the Prime Minister, singing at the opening of the PanAm Games, Olympic qualifier, etc.).

The University requires verification documentation in these circumstances (Queen’s Athletics and Recreation senior management team/Athletics Services Coordinator-Retention for varsity athletic events OR the Vice-Provost and Dean of Student Affairs for other significant events).

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What Students need to do:

1. A minimum of two weeks before the sanctioned event, or as soon as the event is scheduled, complete and submit a Request for Excused Absence for Significant Event form to the Faculty Office by (1) email to asc.accommodations@queensu.ca, (2) fax: 613-533-2467, or (3) in-person at: Dunning Hall, First Floor, 94 University Avenue, Kingston, ON Canada, K7L 3N6. Office hours: Monday to Friday 8:30am to 4:30pm (closed from 12:00pm to 1:00pm). Note: Queen’s varsity athletic events require verification from a member of the Queen’s Athletics and Recreation senior management team/Athletics Services Coordinator-Retention (Athletics and Recreation Centre, 284 Earl Street). Note: Other significant events require verification from the Vice-Provost and Dean of Student Affairs (Gordon Hall, Room 300, 74 Union Street). You will need to include a description of the event, documentation of the invitation to participate, and details regarding the nomination/selection process.

2. Your instructor(s) will receive an email notifying them of your request for academic consideration. 3. As soon as possible, you will need to follow-up with your instructor(s) either by email or in-person to discuss how you will be making up the missed academic requirements. Note: This may require you to complete academic requirements prior to being absent for the event.

4. Complete and submit academic work as agreed upon with your instructor(s).

5. If you require assistance at any point in this process, contact the Faculty Office and ask to speak with an Academic Counsellor.

What Instructors need to do:

1. You will receive an email from the Faculty Office notifying you of the student’s request for academic consideration.

2. As soon as possible, the student will contact you either by email or in-person to discuss the academic consideration request. Note: This may require the student to complete academic requirements prior to being absent for the event.

3. Assess missed academic requirements and provide reasonable academic consideration, while maintaining essential academic requirements and standards. Refer to Information for Instructors – Arrangements that can be authorized by an Instructor, p. 13. Students receiving academic consideration must still meet the learning outcomes for the course.

4. Keep a written record of interactions with the student, the outcome, and action taken to support the student, including only personal details of the student’s extenuating circumstances that are essential to the context. Paper and electronic records should be securely stored and confidentially destroyed as per the University’s records schedule.

What the Faculty Office will do:

1. The Faculty Office will review the form and forward the request to instructors.

2. The Faculty Office will oversee the tracking of requests/forms, copies of which will be kept in the student file.

3. The Faculty Office will work with students and instructors in cases where there are challenges determining reasonable academic consideration.

Information for Students/Delegates

Confidentiality and Privacy: • Students should be aware that privacy and confidentiality will be maintained to the extent possible; however some information may be shared on a need-to-know basis among University personnel (e.g., Faculty Office, instructors, Exams Office, Student Wellness Services, etc.) for the purpose of arranging academic consideration. Confidentiality cannot be maintained where there is reason to believe that a student may be at risk of harming them self or others.

Exclusions that are not covered by this protocol: • Students seeking long-term academic accommodation related to a chronic or ongoing physical or mental health condition or an existing disability should refer to the existing Policy on Academic Accommodations for Students with Disabilities and contact Queen’s Student Accessibility Services (QSAS): 613-533-6467 or accessibility.services@queensu.ca

• Students that are unable to meet academic requirements due to experiencing high levels of academic or exam-related stress should seek out supports and services from Student Wellness Services and contact Tess Grant, Occupational Therapist: 613-533-6000, ext. 75842 or tess.grant@queensu.ca

• Students with a personal or family event to attend (e.g., vacations, weddings), transportation or technological difficulty, or other competing commitments should know that these situations are not considered extenuating circumstances under the Senate Policy on Academic Consideration for Students in Extenuating Circumstances and are not generally supported by the Faculty Office. In these cases, students should consult directly with their instructors who have the discretion to approve or deny these requests.

Missing an accommodated mid-term or final exam: • If a student is currently receiving academic accommodation through Student Wellness Services (i.e., Accessibility Services, Counselling, Health, or the Occupational Therapist) and is unable to attend an accommodated mid-term exam that requires the use of a computer or an accommodated final exam, it is the student’s responsibility (or that of their delegate) to advise the Exams Office immediately by email: exams@queensu.ca. Otherwise, a fee for missing an accommodated exam will be applied.

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Information for InstructorsStudents will submit requests for academic consideration according to the protocol for their home Faculty. As a result, you may receive requests for academic consideration in different ways for different students taking your course(s). If the student’s home Faculty is the Faculty of Arts and Science, you will receive the request for academic consideration by email from the Faculty Office.

Instructors may refer to Procedures and Steps for Requests for Academic Consideration for Students/Delegates and Instructors, p. 6 for detailed information regarding request forms and associated processes for submission.

Academic Consideration can include the following arrangements: • An excused absence, a deferral, an extension, a modified schedule for assignments, projects, labs, or placements, an alternative assignment, a re-weighting of term marks, permission for an incomplete grade, course withdrawal without penalty, or other consideration deemed appropriate by the Faculty Office. Students receiving academic consideration must still meet all essential academic requirements and learning outcomes of the course.

Arrangements that can be authorized by an Instructor:

Instructors should consider the timeline, the student’s circumstances, the course requirements, and the Faculty and departmental policies in determining a reasonable academic consideration. Below is a list of options and some general guidelines instructors can refer to as they determine a reasonable academic consideration:

• Excused absence: No penalty for the student’s absence from a lecture(s), tutorial(s), seminar(s), laboratory(ies), or other attendance or participatory components of the course. All instructors are encouraged to allow for 1-2 absences penalty-free in all courses where attendance or participation marks are assigned. Students can use these excused absences if they are experiencing extenuating circumstances.

• Deferrals: Arranging for the student to write a quiz, test, mid-term, mid-year or final exam at a later date than originally scheduled. The date when the quiz, test, or exam will be written should be set through a discussion between the instructor and the student, based on Faculty and departmental policies, as well as the impact of the extenuating circumstances on the student. Deferrals may also be appropriate if the student experiences the extenuating circumstances before the scheduled quiz, test, or exam resulting in reduced study time or where the student has not yet returned to full capacity (e.g., illness a week prior or on the day of the exam). Deferred exams must be written no later than the end of the subsequent term. Further extensions beyond the set date or the end of the subsquent term require an appeal to the Associate Dean (Studies) (see Information – Arrangements that can be authorized by the Faculty Office through an appeal to the Associate Dean (Studies), p. 14).

• Extensions: Allowing additional time or a modified schedule for completion and submission of term work such as assignments, projects, lab reports etc. The date for the work to be completed should be set through a discussion between the instructor and the student, based on Faculty and departmental policies, as well as the impact of the extenuating circumstances on the student. Incomplete term work can be submitted no later then the end of the subsequent term. Further extensions beyond the set date or the end of the subsequent term require an appeal to the Associate Dean (Studies) (see Information for Instructors – Arrangements that can be authorized by the Faculty Office through an appeal to the Associate Dean (Studies), p. 14). The core intent of this academic consideration is to help students compensate for the time they lose due to their extenuating circumstance while completing scheduled academic tasks. For example, a student may take longer to complete an assignment because they were unable to participate in academic work during a period of illness due to their symptoms. A student may also have a reduced capacity to engage in academic work due to a health condition such as a concussion (e.g., reduced computer screen time) or a personal circumstance such as bereavement (e.g., attending a funeral). Below are some general guidelines regarding extensions that may be helpful to instructors as they consider the request: • 1-2 days on weekly assignments • Up to 5 days on mid-term assignments • 1-2 weeks on term papers

• Alternative assignment: A different type of assignment that assesses similar learning outcomes, taking into account the student’s circumstances (e.g., a written assignment in lieu of an oral presentation, permission to submit individual work rather than group work, written work in place of participation, etc.).

• Re-weighting of marks: Allocation/shifting of marks associated with missed academic work to another upcoming academic requirement (term work only) that assesses similar learning outcomes. This consideration is often used when a student has missed a key piece of academic work (e.g., a written assignment or a mid- term exam). Re-weighting of final exam marks is not permitted. Instructors are encouraged to distribute weight evenly across similar course components where possible to avoid a large percentage of marks being re-weighted to one area of the course or to the final exam.

• Incomplete grade (IN): In cases where term work will not be submitted before the end of the course, or the student is writing a deferred final exam, a final grade of IN (incomplete) may be assigned. The student must have participated actively in the class and only one or two elements of the class may be outstanding. Students with extenuating circumstances who have been unable to complete the majority of the work in a class should consider an appeal to drop a course after the academic deadline rather than requesting an incomplete grade in the course.

• Course withdrawal without penalty before the academic deadline to drop: Refer students to speak with an Academic Counsellor or the Academic Accommodation Counsellor in the Faculty Office to consider dropping a course before the academic deadline. Depending on the timing and impact of the extenuating circumstances, the student may not be able to engage in academic tasks to the extent that dropping the course should be considered. Dropping a course after the academic deadline requires an appeal to the Associate Dean (Studies) (see Information for Instructors – Arrangements that can be authorized by the Faculty Office through an appeal to the Associate Dean (Studies), p. 14).

Arrangements that cannot be authorized by an Instructor:

• Supplemental course work (Academic Regulation 7.4): After completion of the elements of the class that contribute to the determination of a student’s final grade in the class, as outlined in the class syllabus, a student may not submit additional work intended to raise the student’s final grade.

• Supplemental examinations (Academic Regulation 8.1): There are no supplemental examinations in courses offered in the Faculty of Arts and Science. A student who has made any attempt at writing a final examination cannot rewrite an examination at a later time. Regulation 8.1 may not be appealed.

Arrangements that can be authorized by the Faculty Office through an appeal to the Associate Dean (Studies):

• Depending on the amount of work completed in the course, students may have options to appeal to the Associate Dean (Studies). Instructors should refer students to an Academic Counsellor or the Academic Accommodation Counsellor in the Faculty Office for additional information about these options, which may include:

• Aegrotat (estimated) standing in the course • Credit standing in the course • Course withdrawal without penalty after the academic deadline to drop • An extension of an incomplete grade (IN) beyond the one-term deadline to submit incomplete course work or complete a deferred final exam • Detailed information on the appeal process and options can be found at: • Website: www.quartsci.com/academicappeals • Appeal Regulations: www.quartsci.com/appealregulations

• Modified schedule for lectures, labs, tutorial, and placement: A modified schedule may include a student attending a different lecture, lab, or tutorial section if they are unable to attend their current section (e.g., a student taking a medication after a surgery who has difficulty attending an early morning class may temporarily attend another section of the course).

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Arrangements that can be authorized by Student Wellness Services:

• Students seeking short-term academic accommodation (up to 3 months) related to extenuating circumstances (i.e. arrangements that cannot be authorized by an instructor or by the Faculty Office through an appeal to the Associate Dean (Studies) as listed above) should seek out supports and services from Student Wellness Services and contact Tess Grant, Occupational Therapist: 613-533-6000, ext. 75842 or tess.grant@queensu.ca

• Students seeking long-term academic accommodation related to a chronic or ongoing physical or mental health condition or an existing disability should refer to the existing Policy on Academic Accommodations for Students with Disabilities and contact Queen’s Student Accessibility Services (QSAS): 613-533-6467 or accessibility.services@queensu.ca

Suggested Syllabus Template:

• The Faculty Office supplies a template to be used for the class syllabus, with suggested information to be included that relates to academic consideration/accommodation.

Information for Undergraduate Chairs • Act as a departmental resource for instructors by providing advice and guidance to ensure consistency with departmental policies and norms.

• Act as a departmental liaison with the Academic Accommodation Counsellor in the Faculty Office when required.

• Direct Arts and Science students to the Academic Consideration Request Portal (ACRP) to complete the appropriate form to request academic consideration. For additional support, provide students with contact information for the Academic Accommodation Counsellor (see Contacts, p. 17).

Information for Administrative Staff in other Campus Units • Direct Arts and Science students to the Academic Consideration Request Portal (ACRP) to complete the appropriate form to request academic consideration. For additional support, provide students with contact information for the Academic Accommodation Counsellor (see Contacts, p. 17).

Information for Faculty Office Staff, Academic Counsellors • Direct Arts and Science students to the Academic Consideration Request Portal (ACRP) to complete the appropriate form to request academic consideration. For additional support, provide students with contact information for the Academic Accommodation Counsellor (see Contacts, p. 17).

Role of the Academic Accommodation Counsellor, Academic Counsellors and Student Resource Assistants in the Faculty of Arts and Science:

Task Academic Accommodation Counsellor

Academic Counsellors

Student Resource Assistants

Explain the policy, procedures, and protocol to students/delegates. Refer to website for additional information.

Yes Yes Yes

Assist in completion and submission of forms as necessary.

Yes Yes Yes

Protect privacy/confidentiality of students to the extent possible.

Yes Yes Yes

Provide referrals for supports and services on campus. Yes Yes Yes

Provide academic advising to students/delegates. Yes Yes No

Maintain records of all interactions/documentation in the student file.

Yes Yes No

Email instructors when requests for academic consideration and supporting documentation have been reviewed/verified.

Yes No No

Consult with instructors/Departments as necessary to assist in determining a reasonable academic consideration.

Yes No No

Support the coordination of academic consideration across courses and instructors.

Yes No No

Arrangements that can be authorized by an Instructor:

Instructors should consider the timeline, the student’s circumstances, the course requirements, and the Faculty and departmental policies in determining a reasonable academic consideration.

• An excused absence, a deferral, an extension, a modified schedule for assignments, projects, labs, or placements, an alternative assignment, a re-weighting of term marks, permission for an incomplete grade, course withdrawal without penalty, or other consideration deemed appropriate by the Faculty Office. Students receiving academic consideration must still meet all essential academic requirements and learning outcomes of the course.

Arrangements that can be authorized by the Faculty Office through an appeal to the Associate Dean (Studies):

• Depending on the amount of work completed in the course, students may have options to appeal to the Associate Dean (Studies). Academic Counsellors or the Academic Accommodation Counsellor in the Faculty Office can provide additional information about these options, which may include: • Aegrotat (estimated) standing in the course • Credit standing in the course • Course withdrawal without penalty after the academic deadline to drop • An extension of an Incomplete grade (IN) beyond the one-term deadline to submit incomplete course work or complete a deferred final exam • Detailed information on the appeal process and options can be found at: • Website: www.quartsci.com/academicappeals • Appeal Regulations: www.quartsci.com/appealregulations

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Arrangements that can be authorized by Student Wellness Services:

• Students seeking short-term academic accommodation (up to 3 months) related to extenuatingcircumstances (i.e. arrangements that cannot be authorized by an instructor or by the FacultyOffice through an appeal to the Associate Dean (Studies) as listed above) should seek out supportsand services from Student Wellness Services and contact Tess Grant, Occupational Therapist:

613-533-6000, ext. 75842 or tess.grant@queensu.ca

• Students seeking long-term academic accommodation related to a chronic or ongoing physical or mentalhealth condition or an existing disability should refer to the existing Policy on Academic Accommodationsfor Students with Disabilities and contact Queen’s Student Accessibility Services (QSAS): 613-533-6467 or

accessibility.services@queensu.ca

Resources• Student Wellness Services Resources:

• www.queensu.ca/studentwellness/resources

• Queen’s Student Accessibility Services (QSAS):• www.queensu.ca/studentwellness/accessibility-services

• Mental Health Academic Accommodation Resources:• www.quartsci.com/about/in-the-news/collaboration-introduces-new-mental-health-

accommodation-resources

• Faculty of Arts and Science Academic and Appeal Regulations:• www.quartsci.com/academiccalendar

• Faculty of Arts and Science Academic Consideration and Accommodation:• www.quartsci.com/accommodations

ContactsIf you have any questions or require additional support, contact the Academic Accommodation Counsellor in the Faculty of Arts and Science at 613-533-6000, ext. 75413 or asc.accommodations@queensu.ca

Students may also book an appointment to speak with an Academic Counsellor in the Faculty of Arts and Science by calling 613-533-2470 or visiting us at Dunning Hall, First Floor, 94 University Avenue, Kingston, ON Canada, K7L 3N6. Office hours: Monday to Friday 8:30am to 4:30pm (closed from 12:00pm to 1:00pm).

If the situation is of an urgent nature, please seek support from the appropriate on-campus service at Student Wellness Services (146 Stuart Street):

1. Health Services: 613-533-6740, health.services@queensu.ca

2. Counselling Services: 613-533-6000 ext. 78264, counsellingservices@queensu.ca

3. Occupational Therapist: 613-533-6000 ext. 75842, tess.grant@queensu.ca

4. Accessibility Services: 613-533-6467, accessibility.services@queensu.ca

You can also seek support and services from the Sexual Violence Prevention and Response Coordinator or the Human Rights Office:

1. Sexual Violence Prevention and Response Coordinator: 613-533-6330, bjl17@queensu.ca2. Human Rights Office: 613-533-6886, hrights@queensu.ca3. University Ombudsman: 613-533-6495, ombuds@queensu.ca

Forms

* If you are unable to write a final exam AND you have exam accommodations through QSAS, you must notify the

Exams Office (613-533-2101 or exams@queensu.ca) or you will be charged a no-show fee.

.

Self-Declaration of Brief Absence (up to 48 hours)

This self-declaration is in place of a sick note/supporting documentation from Student Wellness Services or a community health professional. No additional documentation is required.

Course: _________________________Term: ________ Instructor: ______________________________

Academic requirement missed during brief absence for this course:

Written assignment Quiz

Comprehensive Exam Thesis / Dissertation Obligation

Attendance / Participation Marks Test Oral Presentation Lab / Tutorial / Seminar Group Work Placement / Fieldwork Mid Term Exam Final Exam* Other:

I am submitting this self-declaration as a request made in good faith for academic consideration for a maximum of 48 hours at which point I expect to resume all academic obligations. (Please initial) _____ _____ _____

I declare that I am unable to attend class or complete academic work due to experiencing an acute illness or distressing situation that has temporarily impaired my physical or mental health. I understand that it is my responsibility to submit this form as soon as the need is apparent (and no later than 24 hours after the end of my brief absence), and to follow-up with my instructor(s) about missed academic requirements. I understand that providing any false or misleading information, or using this form to delay or avoid fulfilling academic requirements, constitutes a breach of academic integrity as outlined in the Queen’s University Senate Policy on Academic Integrity Procedures. For Faculty/ School specific academic integrity policies, go to http://www.queensu.ca/academicintegrity/home

Student Signature: _________________________________ Date: __________________

I consent for the following person (name) ____________________________ to act as a delegate on my behalf (i.e. submit documentation, liaise with Faculty / Instructors) as I am currently unable to take action for myself. Please note if a student is incapacitated, a substitute decision maker/attorney may act on their behalf without the student signature.

Student Signature: ______________________ Relationship to Delegate: ______________________

The protocol for submitting this form is determined by the Faculty / School that is granting your degree, please see your Faculty / School Protocol. General information about submission is on the next page. The form needs to be submitted either during your brief absence or in cases where you are too unwell, within 24 hours of the end of your brief absence. If your absence impacts the class (i.e. presentation / group work), please inform your course instructor.

Student Name: __________________________

Student Number: __________________________

Queen’s Email: __________________________ Date(s) of Brief Absence:__________________

Section A: Academic Requirements Needing Consideration

Section B: Self Declaration of Brief Absence

Section C: Delegate

Section D. Submitting this Form

Information about Self-Declaration of Brief Absence (less than 48 hours)

When should this form be used?

If you (a student) are experiencing an unexpected acute illness (e.g. stomach flu) or distressing event (e.g. family member in a serious car accident) that has led to physical or psychological impairment of sufficient severity that you feel you are temporarily unable to meet required academic requirements.

This is for brief absences where you expect to return to full academic functioning within 48 hours. Submit this form as per the directions below during your brief absence or within 24 hours of the end of

your brief absence. Submit to your home Faculty/School even if a course is in another Faculty/School. What Faculty / School is granting your degree?

▪ Arts and Science: Submit the form to instructors through the online portal. ▪ Engineering & Applied Sciences: Submit the form (hard copy) to Rm 300 Beamish Munro Hall. ▪ Nursing: (BScN), submit the form (email or hard copy) to Barb Bolton (Rm 113) ▪ Education (B.Ed): Submit the form (email or hard copy) to Alan Wilkinson (Rm A101a) ▪ Commerce: Submit the form (email or hard copy) to instructors or the Faculty Office ▪ Law: Submit the form (email or hard copy) to Helen Connop (Rm 107) ▪ Medicine: Submit the form (email or hard copy) to the Learner Wellness Centre ▪ Graduate Students: Submit the form (email or hard copy) to your instructor(s) or supervisor

What if my illness or distress lasts more than 48 hours?

In cases where you anticipate needing an additional day or two beyond 48 hours and are comfortable sharing your circumstances, please speak with your instructor. It isn’t uncommon for an acute illness to last longer than 48 hours and instructors have discretion to consider the circumstances and extend academic considerations for brief absences beyond 48 hours. If you anticipate you will need consideration for a longer period of time or if your instructor does not extend the brief absence, you will need to complete a Request for Academic Consideration for Extenuating Circumstances form and submit it to your Faculty Office

When should this form not be used?

For classes where there are no marks associated with your absence. Any reason for absence other than an unexpected acute illness or significantly distressing event. If you have a personal or family event (e.g. vacations, weddings) to attend, transportation or

technological difficulty, or other competing commitment you should consult directly with your instructors or with the Faculty / School Office rather than completing this form.

If you feel you are unable to meet academic requirements due to experiencing high levels of academic stress, exam related anxiety, or due to an ongoing health condition, you should go to Student Wellness Services and discuss short term or long term academic accommodations.

Do I need to get documentation from a doctor or other professional to support my brief absence?

No. This self-declaration replaces the need for a sick note/supporting documentation. Acute illnesses may take a few days to resolve and students who are acutely ill (i.e. vomiting, diarrhea, fever) should remain at home and rest to avoid spreading illness to their peers and others. Student Wellness Services does not provide documentation for brief, acute self-limiting illnesses.

What academic consideration might I receive?

Your instructor will consider the timeline, the course requirements, and your Faculty / School academic policies in determining a reasonable academic consideration. Considerations may include: an excused absence, an extended or deferred deadline, a modified schedule for assignments, labs, placements, projects or comprehensive exams, a deferred exam or project, an alternative assignment, or a re-weighting of marks.

Completion of this form constitutes a request. Approval of academic consideration lies with the Instructor / Supervisor and / or Faculty / School office.

Request for Academic Consideration for Extenuating Circumstances (anticipate need for consideration for up to 3 months)

Section A: Extenuating Circumstances and Supporting Documentation (see Faculty / School protocols for required supporting documentation)

Check boxes for attached supporting documentation 1. Personal Health Condition or Injury

Completed Verification of Personal Health Condition Form Other documentation: ___________________________

4. Compassionate / Personal Accident report Police report Court order / report Medical report Letter from Professional Other documentation: ____________

2. Bereavement Obituary Other documentation: ____________________________

3. Confidential Completed Confidential Verification Form Other documentation: ____________________________

5. Documentation still to be determined6. Documentation not yet available7. Other documentation: _____________

Current 1) ____________________ Term:_______ 2) ____________________ Term: ________

Courses: 3) ____________________ Term:_______ 4) ____________________ Term: ________

5) ____________________ Term:_______ 6) ____________________ Term: ________I understand that it is my responsibility to provide this form (myself or through a delegate) to my Faculty/School (in person or by email) as soon as the need is apparent and to negotiate making-up any missed academic requirements. I understand that providing any false or misleading information constitutes a breach of academic integrity as outlined in the Queen’s University Senate Policy on Academic Integrity Procedures. For academic integrity policies, see http://www.queensu.ca/academicintegrity/home

Student Signature: ____________________________ Date: ____________________________

I consent for the following person (name) ____________________________ to act as a delegate on my behalf (i.e. submit documentation, liaise with Faculty / Instructors) as I am currently unable to take action for myself. Please note if a student is incapacitated, a substitute decision maker/attorney may act on their behalf without the student signature.

Student Signature: ______________________ Relationship to Delegate: ______________________

Please submit this form to your Faculty / School Office as soon as it becomes apparent that you are having difficulty meeting academic requirements due to an extenuating circumstance. Please see your Faculty / School protocol for specific details related to submitting this form and for next steps.

Student Name: __________________________ Student Number: ____________________________

Queen’s Email: __________________________ Date of anticipated full recovery: _______________

Request for Academic Considerations starting on (date): ____________________________________________

Section B: Courses with Academic Requirements Needing Consideration

Section C: Delegate

Section D. Submitting this Form

Information about Requests for Academic Consideration for Extenuating Circumstances

When should this form be used?

If you (a student) are experiencing extenuating circumstances that have led to a reduced ability to meetacademic requirements and you anticipate being able to return to full academic functioning within 3months. This could include an extended unanticipated illness (e.g. pneumonia, mononucleosis,) a seriousinjury (e.g. concussion, broken bones), a required treatment (e.g. surgical procedure, significant side effectsfrom new medication), serious injury or illness to a significant other, bereavement, traumatic event, or othersignificant personal crisis. The degree of your impairment related to the circumstances may mean that youare able to complete some academic requirements but not others.

What if my illness or distress might last more than 3 months?

As soon as it is determined that limitations associated with the extenuating circumstance will likely bepresent beyond 3 months, you should contact Queen’s Student Accessibility Services (QSAS) and seekacademic accommodations. You should also meet with an academic advisor in your Faculty / School todiscuss your academic progress and the options that are best for you given your extenuating circumstances.

When should this form not be used?

If your current extenuating circumstances relate to an issue for which you are already receiving short termor long term academic accommodations from Student Wellness Services (Health, Counselling orAccessibility Services). In those cases, please follow-up with your SWS service provider.

If you are unable to meet academic requirements due to functional limitations related to an underlying disabilityor diagnosed health condition you should register with Queen’s Student Accessibility Services (QSAS) todiscuss academic accommodations. This would include experiencing an exacerbation of an existing conditionthat had not previously required accommodation (e.g. Crohn’s disease, anxiety) or the new onset of a physicalor mental illness (e.g. diabetes, depression), or a recovery that is slower than anticipated (e.g. complicated grief,post-concussion syndrome, medical complications, post-traumatic stress)

What is the difference between academic considerations and academic accommodations?

Academic considerations are determined by the instructor and are related to your progress in the course.Your instructor will consider the timeline, your circumstances, the course requirements, and your Faculty /School academic policies in determining reasonable academic considerations. Considerations may include:an excused absence, an extended deadline, an alternative assignment, a re-weighting of marks, a modifiedschedule for assignments, labs, placements, projects or comprehensive exams, a deferred assignment, examor project, a medical leave of absence, a course withdrawal without penalty or other as appropriate. Studentsmust still meet the course academic requirements.

Academic accommodations are specific to removing barriers in the academic environment that are createdby your impairments and limitations and are provided through Student Wellness Services. Academicaccommodations can be short term or long term and include both classroom and exam accommodations (i.e.extra time for an exam, a different space for writing tests, assistive technology, specialized equipment,alternatives to group work) and are tailored to the individual circumstances.

o If your extenuating circumstances are complex or you think you might need academicaccommodations at any point, please contact Student Wellness Services.

Do I need to get other documentation to support my extenuating circumstances?

In many cases, your Faculty / School Office will require additional documentation in support of yourrequest for academic consideration. The specific documentation will be determined by the extenuatingcircumstances you experience, and through discussion with your Faculty / School Office. For health relatedcircumstances, please use the Verification of Personal Health Condition form. There is also a Verificationof Confidential Extenuating Circumstances you can use if your specific situation requires confidentiality.

Verification of Personal Health Condition This form is to verify a physical or mental health condition or injury that temporarily limits a student’s academic participation or ability to meet academic requirements.This applies to extenuating circumstances where a full recovery and return to previous levels of academic functioning is anticipated to happen within the next 3 months.

Student Name: ________________________

Student Number: __________________________

Queen’s email: ________________________ Phone number: ___________________________

Section A: Authorization to Share Information - Completed by Student I authorize the health care provider named below to complete this form in support of my request for academic considerations. This form will be submitted to the designated individual(s) in my Faculty / School office and may be shared with instructors or university personnel solely on a need to know basis.

Student Signature: _____________________________ Date: _____________________________

Section B: Verification of Personal Health Condition - Completed by Regulated Healthcare Provider I certify that my assessment of this student and their level of impairments fall within my legislated scope of practice. On the basis of my examination and applicable documented history, I verify that this student is experiencing a health condition that is impairing their academic functioning. The following information is provided for Queen’s University to use in determining short term academic considerations.

Date(s) I assessed this student’s health: ___________________________________

Date of onset of health condition: ________________________________________

Anticipated full recovery: < 1 week 1 – 2 weeks 2- 4 weeks 4 – 8 weeks 8- 12 weeks

Date / Timeline for follow-up assessment:_________________________________________________

Impairment in Academic Functioning

Impairment Characteristics N/A Mild Moderate Serious Severe The student is impaired

on… Occasional days Some days Most days All days

The student is impaired for… A short time

during the day Multiple times during the day

The majority of the day

Throughout the entire day

The quantity of academic work will need to be… Occasionally

reduced Somewhat reduced

Significantly reduced

Can not complete academic work

The quality of academic work will likely be … Minimally

affected Somewhat affected

Significantly affected

Can not produce academic work

Specific functional limitations the student experiences that directly affects their ability to meet academic requirements (e.g., ability to attend classes in the morning, sit or stand for extended periods of time, use screens, etc )

Name: _______________________________ Profession / Position: ___________________________

Signature: _____________________________________ Date: ______________________________

Telephone # (if not Student Wellness Services): _________________________________

Address (if not Student Wellness Services): ______________________________________________

Verification of Confidential Extenuating Circumstance This form is to verify a confidential extenuating circumstance (not a health condition) that temporarily limits a student’s academic participation or ability to meet academic requirements.This applies to extenuating circumstances where a full recovery and return to previous levels of academic functioning is anticipated to happen within the next 3 months.

Student Name: _________________________

Student Number: ________________________

Queen’s email: ________________________ Phone number: __________________________ Section A: Authorization to Share Information - Completed by Student

I authorize the person named below to complete this form in support of my request for academic considerations. This form will be submitted to the designated individual(s) in my Faculty / School office and may be shared with instructors or university personnel solely on a need to know basis.

Student Signature:________________________________ Date: ___________________________

Section B: Verification of Confidential Extenuating Circumstance Based on my professional assessment I have determined that this student is experiencing an extenuating circumstance that requires academic consideration. I have interacted with the student, reviewed documentation, and/or spoken with reliable others, and have confidence that the extenuating circumstances are verifiable and are having an impact on the student’s current ability to meet academic requirements. An assessment of the student’s functioning related to the specific circumstance is within the scope of my professional practice. I believe that a confidential verification is in the best interest of the student at this time.

Date(s) I interacted with this student: ___________________________________

Date of onset of extenuating circumstances: ________________________________________

Anticipated full recovery: < 1 week 1 – 2 weeks 2- 4 weeks 4 – 8 weeks 8- 12 weeks

Date / Timeline for follow-up assessment:_________________________________________________

Impairment in Academic Functioning

Impairment Characteristics N/A Mild Moderate Serious Severe The student is impaired

on… Occasional days Some days Most days All days

The student is impaired for… A short time

during the day Multiple times during the day

The majority of the day

Throughout the entire day

The quantity of academic work will need to be… Occasionally

reduced Somewhat reduced

Significantly reduced

Can not complete academic work

The quality of academic work will likely be … Minimally

affected Somewhat affected

Significantly affected

Can not produce academic work

Specific functional limitations the student experiences that directly affects their ability to meet academic requirements (e.g., ability to attend classes in the morning, sit or stand for extended periods of time, use screens, etc )

Name: _______________________________ Profession / Position: _________________________________

Signature: _____________________________________ Date: ____________________________________

Contact # or Email: _____________________________ Department / Agency: _________________________

Completion of this form constitutes a request.

Request for Excused Absence for Significant Event

This form should be completed and submitted to Instructors or the Faculty/ School office (see your Faculty / School protocol) a minimum of 2 weeks before the event, or as soon as the event is scheduled if less than two weeks’ notice available.

Event Details Varsity Athletic Event Other Significant Event

Level of Event: Provincial National International _________________________

Event Organizing Body:_______________________________________________________________

Dates of required absence:___________________ Dates of event: _____________________ Nature of Invitation: __________________________________________________________________

Description of Event:

Event Verification I verify that _____________________________ (name of student) has a commitment to attend the event described above. I support this student’s request to represent Queen’s University through participation at this event. The student is aware of their obligation to negotiate a plan for the completion of all assigned work and academic obligations.

Athletic Events (To be signed by a member of the senior management team or delegate)

Name: _______________________ Signature: ______________________ Date: ___________

Other Significant Events (To be signed by the Vice-Provost and Dean of Student Affairs or delegate)

Name: _______________________ Signature: ______________________ Date: ___________

Other Significant Event

Please attach all documentation related to the nature of the event, and your invitation to participate as a distinguished guest. Include a personal statement explaining why you feel this is an essential event for you to attend and how your participation showcases your abilities.

Student Signature:________________________________ Date: ___________________________

Student Name: __________________________ Student Number: __________________________

Queen’s Email: __________________________ Phone Number:___________________________