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Concussion Temporary Academic Modifications (To be provided to teachers when student has experienced a suspected concussion with a pending medical evaluation.) Student Name: DOB: Homeroom Teacher:
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How to fill out concussion temporary academic modifications

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How to fill out concussion temporary academic modifications

01
Begin by obtaining the concussion temporary academic modifications form from your school's administration office.
02
Carefully read through the form and understand the information provided.
03
Fill out the student information section, including your name, contact details, and student ID if applicable.
04
Specify the date of concussion and provide details about how and where it occurred.
05
Clearly list the academic modifications needed due to the concussion. This may include extended time on exams, reduced workload, or additional breaks during the school day.
06
If applicable, provide any medical documentation or reports supporting the need for these academic modifications.
07
Review the completed form for accuracy and make any necessary corrections.
08
Sign and date the form, indicating your agreement to abide by the concussion temporary academic modifications.
09
Submit the filled-out form to the appropriate authority in your school's administration office.
10
Follow up with the administration office to ensure that your academic modifications are being implemented as requested.

Who needs concussion temporary academic modifications?

01
Concussion temporary academic modifications are typically needed by students who have suffered a concussion and require support and accommodations to continue their academic pursuits.
02
This can include students of all ages, from elementary school through college.
03
Individuals who experience symptoms such as headaches, dizziness, difficulty focusing, memory problems, or sensitivity to light or noise after a concussion may require academic modifications to ensure they can learn and perform to the best of their abilities while they recover.
04
It is important to consult with a healthcare professional, such as a doctor or school nurse, to determine if concussion temporary academic modifications are necessary.
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Concussion temporary academic modifications are adjustments made to a student's academic requirements and accommodations to support their recovery from a concussion.
School administrators, counselors, or healthcare providers are required to file concussion temporary academic modifications.
Concussion temporary academic modifications can be filled out by providing specific details of the student's concussion diagnosis, academic adjustments needed, and any accommodations required.
The purpose of concussion temporary academic modifications is to ensure that students recovering from a concussion receive the necessary support to continue their education without worsening their condition.
Information such as the date of concussion diagnosis, academic adjustments needed, healthcare provider's recommendations, and expected recovery timeline must be reported on concussion temporary academic modifications.
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