Request for Course Accommodation Due to Religious Observance

According to the IUPUI Policy on Religious Holidays, any student who is unable to attend classes or participate in any examination, study, or work requirement on some particular day or days because of his or her religious beliefs must be given the opportunity to make up the work that was missed or to do alternative work that is intrinsically no more difficult than the original exam or assignment.

The instructor and the student should discuss what a reasonable accommodation would represent. This could be the same work with a different due date, or a substantially similar exercise at another time. However, any accommodation that is mutually agreeable to both student and faculty member is acceptable.

Requests for accommodation for religious observance must be made in writing and returned to the instructor by the end of the second week of the semester.

Course Information:

Department: _____________ Course Number:____________ Class Number: _________

Instructor: __________________________________________________________

Student Information:

Name: ____________________________________________________________

Ten Digit University ID number: ____________________

University E-mail Address: ________________________ Phone: ___________________

Select one checkbox and provide the date below:


Pursuant to the IUPUI Policy on Religious Holidays, I request accommodation for a course activity scheduled for the following date. Pursuant to the IUPUI Policy on Religious Holidays, I request accommodation for course activity scheduled around the following approximate date.
Date:________________________________ Date:________________________________

Once exact date is known, I understand it is my responsibility to immediately notify my instructor to work out any requested accommodations.

Suggested accommodation (e.g. makeup examination)________________________________________


Student Signature

Today's date