Special Considerations Form

Student ID #:*

Full Name:*

First Name(s)Last Name(s)

Program:*

Phone Number:*

Area CodePhone Number

E-mail Address (MyGeorgian):*

Timing:*

Missed TestMissed Assignment DeadlineFuture Request

Reason for Consideration:*

Short-Term Medical situations (from 1 day to 2 weeks)Medium-Term Medical situations (from 2 to 5 weeks)BereavementOther

Please reach out to our Health and Wellness team via email at healthcare@ilac.com within 1-2 business days to describe the reason for your request with supporting documentation. Failure to contact within the specified timeframe may result in immediate closure of your request.

Have you received accommodation for a diagnosed Learning Disability:*

YesNo

Instructions for Course Name and Code field below:

(Course CRN, Course ID)

(for multiple courses please provide list of all course CRN/ID)

Course Name and Code *

Assessment (test / assignment)*

Consideration requested (for instance, waiver of late penalty)*

Assessment Weight

Assessments worth 20% or less of the final mark are not in scope for this process. Please discuss your request directly with your instructor.

Assessment Weight*

Please describe the reason for your request. Attach supporting documentation, which might include a funeral notice, travel documents or other material related to your application for consideration*

Upload Supporting Documents

Browse Files

I confirm that the information provided is complete & accurate. I understand that it is my responsibility to inform my instructors about absences in a timely manner so that appropriate arrangements can be made. Student Signature:*