Religious Observance Request Form

"*" indicates required fields

Name *

First Last

Email *

School and Program/Major *

Pharmacy and Health Professions students must submit a copy of this form, once approved, to whomever grants excused absences within your respective school.

Year of Graduation *

If your request pertains to dietary needs, please describe them here (if you are fasting at particular times or are looking for some type of food that you do not see at the dining hall such as Halal, Kosher, etc.)

Course Affected by Request

Your Professor's Email Address

What is the date, time, and location of the religious observance for what you are seeking accommodations?

State how the religious observance conflicts with your academic schedule and what specific accommodations you are requesting.

By checking this box, you also understand that the accommodation may not be granted, but that Shenandoah University will do its best to provide a reasonable accommodation to you. *

Yes, I understand.

No, I decline.

Name

This field is for validation purposes and should be left unchanged.