Get the free Concussion Temporary Academic Modification Form

Concussion Temporary Academic Modification Form Student Name: DOB: Homeroom Teacher: Grade: The above student has been deemed to have signs/symptoms consistent with a concussion. To initiate appropriate

How to fill out concussion temporary academic modification

How to fill out a concussion temporary academic modification:

1. Obtain the necessary forms: Contact your school or academic institution to request the concussion temporary academic modification form. They may have specific paperwork or guidelines for you to follow.
2. Fill out personal information: Provide your full name, student identification number, contact information, and any other details required on the form. This will ensure that the modification is applied to the correct individual.
3. Specify the duration of the modification: Indicate the start and end date for which you require the temporary academic modification due to the concussion. It's essential to be as accurate as possible when determining these dates.
4. Describe the concussion and its impact: Use the provided space to detail the nature of your concussion, such as how and when it occurred, symptoms experienced, and any medical advice or diagnosis you have received. This information will help the academic institution understand the severity of the situation.
5. Identify desired academic modifications: Clearly outline the accommodations or modifications you are requesting due to your concussion. This could include extensions on assignments, rescheduling of exams, additional time for completing tasks, or any other necessary adjustments that will help you cope with the effects of the concussion.
6. Include supporting documentation: If available, attach any medical documents or notes from healthcare professionals relating to your concussion, such as doctor's letters or medical reports. These documents can strengthen your request and provide further context for your academic institution.
7. Review and sign the form: Before submitting the concussion temporary academic modification form, carefully review all the information you have provided. Make sure there are no errors or missing details. Sign and date the form as required.

Who needs a concussion temporary academic modification:

1. Students who have been diagnosed with a concussion: Individuals who have suffered a concussion and have a medical diagnosis to support their condition may need to request a temporary academic modification. This modification aims to provide necessary accommodations to aid in their recovery process.
2. Students experiencing concussion symptoms: Even without an official diagnosis, students experiencing concussion symptoms such as headaches, dizziness, confusion, memory problems, or difficulty focusing may also require a temporary academic modification. This allows them to adjust their workload or schedule to better manage their symptoms.
3. Athletes or individuals involved in physical activities: Concussions are commonly associated with sports or activities that involve head injuries. Athletes or students participating in such activities who sustain a concussion may require a temporary academic modification to ensure they can continue their education while prioritizing their recovery.

It's important to note that the specific criteria for eligibility to request a concussion temporary academic modification may vary between academic institutions. Students should consult their school's policies or reach out to their academic advisor for guidance on the process.

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What is concussion temporary academic modification?

Concussion temporary academic modification is a plan put in place to provide academic accommodations for students who have suffered a concussion.

Who is required to file concussion temporary academic modification?

Parents or guardians of students who have suffered a concussion are required to file for concussion temporary academic modification.

How to fill out concussion temporary academic modification?

To fill out concussion temporary academic modification, parents or guardians must submit a request form along with documentation from a medical professional confirming the concussion.

What is the purpose of concussion temporary academic modification?

The purpose of concussion temporary academic modification is to ensure that students have the necessary accommodations to continue their academic work while recovering from a concussion.

What information must be reported on concussion temporary academic modification?

Concussion temporary academic modification must include information about the student's diagnosis, recommended accommodations, and expected duration of the modifications.