Eastern Kentucky University
Office of Services for Individuals with Disabilities
Modified Attendance Written Plan Agreement
Students with disabilities approved for consideration of a modified attendance policy from the OSID shall present this
form accompanied with their Accommodation Letter to their instructors.
Students are asked to have a face-to-face meeting, or for a WEB based class correspond by email or via phone to discuss
completion of this form. Completion of this form will act as an agreement between the student and an instructor as to how
the modified plan will be implemented and will set the guidelines for the student to follow to achieve completion of the
course with the agreed upon modifications.
Please refer to the OSID Modified Attendance Policy Protocol for guidance in creating this agreement. Once an
agreement has been reached, both parties will sign and date the form.
Student (printed name): _________________________________________________________________
Course Name and Number: _______________________________________________________________
Course Instructor: ______________________________________________________________________
Semester and Year: ______________________________________ (example Fall 2012)
This is the manner in which regularly scheduled course meetings and requirements will be modified:
The method by which the student should contact the instructor is ________________ (phone, email, other). Contact must
be made in advance of an anticipated absence to have that absence considered excused. In advance specifically means:
_______________________________ (example: 1 day in advance or 2 hours in advance).
For emergencies or unexpected absences, student is expected to contact the instructor in this
manner:__________________________________________________________________________________
A modified, maximum number of absences for this course would be:__________________________________
If absences start to reach the agreed upon limit, the following will occur:_______________________________
_________________________________________________________________________________________
If absences exceed the agreed upon limit, the following will occur:___________________________________
__________________________________________________________________________________
Course requirements including exams, quizzes, assignments, papers and projects, and other work will be made up in this
manner: __________________________________________________________________________________
__________________________________________________________________________________________
Other considerations for this agreement include: ___________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
STUDENT SIGNATURE
DATE
__________________________________________________________________________________________
INSTRUCTOR SIGNATURE
DATE
Make copies for each party. Please address questions regarding this plan to the Disabilities Office 859.622.2933