Before you begin to fill in this form, make sure you have: student ID number course title, course code, instructor, and exam date and time for each exam for which an accommodation is being requested * Indicates required field Please confirm if an exam accommodation may be granted for your particular exceptional circumstances prior to submitting this form. Full name *This field is required. Mount Allison student ID *This field is required. Mount Allison e-mail *This field is required. Accommodations requested I am applying for accommodation for the following exam(s) Re-order Course title Course code Instructor name Exam date and time Weight Operations Course title Course code Instructor name Exam date and time Item weight Add more items more items Click on the "Add" button to include additional exams My request is based on the following circumstance Request circumstances Student illness Death or funeral Medical issues Car accident/breakdown Weather issues Religious grounds Compassionate Other reason Enter other reason… Additional details I am able to provide appropriate documentation to support my request if asked Yes No I understand that misrepresentation of an illness or circumstances constitutes academic dishonesty *This field is required. Circumstances are listed on the exam information page. Have you previously applied for exam accommodation at Mount Allison? Yes No More than once If I am granted an exam accommodation, I am eligible for services provided by either The Meighen Centre or the student life office. Yes No By submitting this form, I acknowledge having read and understood the information detailed on this form. *This field is required. CAPTCHA
