Request For Religious Accommodation Form printable pdf download

UNC CHARLOTTE

REQUEST FOR ACCOMMODATION FOR RELIGIOUS OBSERVANCE

This form should be submitted by the student to the instructor no later than the census date for enrollment for a given semester (typically

the tenth day of instruction). The census date for each semester can be found in

UNC Charlotte’s academic

calendar. Excused absences

from classes or examinations for religious observances will not be counted against any mandatory attendance requirements, but they do

not relieve students from responsibility for any part of the course work required during the period of absence. The instructor may

appropriately respond if the student fails to satisfactorily complete any alternative assignment or examination. For more information

regarding UNC Charlotte’s policy regarding the Religious Accommodation for Students, see

University Policy

409.

Student Information

(to be completed by requesting student)

Name of student: __________________________________________________ Date of submission: _________________________

Charlotte ID number: _____________________________ E-mail address: _____________________________________________

Instructor name: _____________________________________________________________________________________________

Department: ______________________________ Course section, number and name: ___________________________________

Request Information

(to be completed by requesting student)

A reasonable accommodation for a religious observance is any change in an academic course or program of study with respect to the way

tasks or responsibilities are customarily done that enables a student to observe his/her religious practice or belief without imposing undue

hardship on UNC Charlotte. Please provide the following information:

What specific class accommodation(s) do you request (e.g., excused absence, rescheduling of an exam or other class

requirement)?

_____________________________________________________________________________________________________________

Please identify your religious practice or belief and state how the requested accommodation enables you to participate in your

religious practice or belief.

_____________________________________________________________________________________________________________

Please state the date[s]/frequency of requested accommodation within the academic semester.

_____________________________________________________________________________________________________________

(IF NECESSARY, PLEASE USE ADDITIONAL SHEETS FOR ANY OF THE INFORMATION REQUESTED ABOVE)

_____________________________________________________________________________________

Religious Tenet(s) Documentation

I verify that the above information is complete and accurate to the best of my knowledge and I understand that any intentional

misrepresentation contained in this request may result in disciplinary action. I acknowledge that UNC Charlotte may ask me to

document my religious practice or belief or consult religious scholars or leaders to confirm the appropriateness of the requested

accommodation.

Student Signature:_____________________________________________________________

Date:__________________________

Request For Religious Accommodation Form