Forms

New Student Wellness Patients

To help speed up your registration process, please fill out the following form and email it to health.services@queensu.ca prior to your first medical or mental health appointment. Please note that if your paperwork is not completed and submitted prior to your appointment, it may not be possible to proceed and we may need to reschedule. 

If you are a student with a disability and would like to register with Accessibility Services, please click here


Extenuating Circumstances

 

Info for Students

Your studies may be impacted by illness or unexpected events during your time at Queen’s. The university has developed a policy outlining the approach to providing students with extenuating circumstances with consistent and fair academic consideration. 

Find where to go for support if you have a circumstance impacting your academics

Do You Have an Extenuating Circumstance?

An extenuating circumstance is a personal circumstance beyond your control, (e.g., sudden or acute physical illness or mental distress, serious injury to yourself or significant others, bereavement, traumatic event, etc.) that has a direct and substantial impact on your ability to temporarily meet essential academic requirements or standards. 

The Policy on Academic Considerations for Students in Extenuating Circumstances enables students with extenuating circumstances to request academic consideration in a fair, reasonable and consistent manner.

Academic Consideration vs Academic Accommodations

Academic Considerations

Academic consideration is an action taken by an educator in response to a student with an extenuating circumstance. Academic considerations are intended to minimize the impact of a serious or significant extenuating circumstance that is beyond a student’s control. Considerations may include but are not limited to: an excused absence, a brief reprieve from coursework, extended or deferred deadline, a modified schedule for assignments, labs, placements, projects, or comprehensive exams, a deferred exam or project, a medical leave of absence, an alternate assignment, a re-weighting of assigned marks, course withdrawal without penalty, or other considerations deemed appropriate by a Faculty or School Office.

Academic Accommodations

Academic accommodations are put in place to equalize learning opportunities and access to the academic environment for students with disabilities. A disability may include a temporary (e.g., a concussion or a broken arm) or permanent (e.g., a learning disability) condition. The functional limitations resulting from a disability can at times intersect with the academic environment in a way that creates a barrier for students. Some examples of accommodations include extra time on exams, permission to use assistive technology for exams, or permission to audio record lectures.

If you have a valid extenuating circumstance (see description above) AND are not currently registered with Accessibility Services (QSAS) or are registered with QSAS but your extenuating circumstance is unrelated to your disability, you may submit a request through the Policy on Academic Considerations for Students with Extenuating Circumstances.

If you are already registered with QSAS and your request for academic consideration is related to your disability (e.g., irritable bowel flare up), contact your Accessibility Services Advisor. If your request is time sensitive (e.g., your exam or deadline is within the next 24 hours) email your instructor and/or course coordinator and cc your advisor. If you are requesting a deferral for a centrally scheduled final exam, email the Exams Office (exams@queensu.ca) to cancel your exam accommodations. If you are uncertain about who your advisor is please email accessibility.services@queensu.ca or call 613-533-2506.

If you are uncertain about whether your extenuating circumstance is valid, please email intake.wellness@queensu.ca or call 613.533.6000 X 74842 for assistance.

Here are steps to take if a circumstance outside your control (e.g., health condition, family member death, challenge with housemates, etc.) is impacting your academics:

  1. Do you need medical or mental health care (e.g., appointment with physician, counsellor, nurse, occupational therapist)? If yes, book an appointment at Student Wellness Services.
     
  2. Are you registered with Accessibility Services (QSAS) for the circumstance that is currently impacting your academics?
    1. If yes, email your course instructor(s) and CC your QSAS Advisor with your request for accommodation.
    2. If no, how long do you think your circumstance will impact your academics?
      1. If 3 days or less – Complete the Request for Academic Consideration Form. No medical documentation is required. Follow instructions in Section F for individual Faculty/School. Students in Arts and Science, Commerce, and Engineering may need to complete the Formal Attestation Form as their supporting documentation (see section F).
      2. If 3 days or more – You will need supporting documentation for your consideration request. Documentation needed may vary depending on the nature of your circumstance (see “what supporting documentation do I need?” below). If you are seeing a healthcare provider, ask for documentation.

If you have an ongoing disability or diagnosed health condition, we encourage you to consider registering with Queen’s Student Accessibility Services (QSAS) for ongoing accommodations, when you are able. Find out how to register with QSAS and disability documentation requirements.

Supporting documentation can include the following:

Students who experience unforeseen technological or workspace disruptions that are beyond their control (e.g. hardware malfunction, unexpected internet connectivity issue, power outage, fire alarm, unexpected need to care for children, etc.) can apply for academic consideration during the 2020-21 school year. For more information about how to apply for this academic consideration, click on your individual Faculty/School website found in the section below.

Students who experience chronic technological difficulties or workspace disruptions (e.g. long-term hardware/software failure, prolonged poor internet coverage, lack of planning or knowledge of program software/onQ, missing notifications/reminders, use of unsupported/out-of-date software, etc.) would not qualify for academic consideration. Students requiring financial assistance to plan and mitigate against chronic disruptions are encouraged to apply for bursary funding from Student Awards.
 

Request for Academic Consideration 

  • Submit this form for all academic requests
  • Follow instructions for the Faculty/School that is granting your degree

Verification of Personal Health Condition 

  • For personal health issues
  • You must have this form completed when you meet with a health care professional (on-campus or in the community)
  • Provide the filled-out form to your Faculty/School office

Verification of Confidential Extenuating Circumstances 

If your extenuating circumstances are not for a health condition, but you are not comfortable disclosing the specifics of the situation, then a support professional at Queen's (e.g., Chaplain, Human Right Advisor, Sexual Violence Prevention and Response Coordinator) who is aware of your situation can complete this form.

Request for Excused Absence for Significant Events 

Complete this form if you are participating in an event at the provincial, national, or international level that is either a Queen's Varsity Athletics event, or an event to which you were invited as a distinguished guest.


 

Info For Faculty and Staff

A student’s studies may be impacted by illness or unexpected events during their time at Queen’s University. The university has developed a policy to outline the approach to providing students with extenuating circumstances with consistent and fair academic consideration.

Academic Considerations

Academic consideration is an action taken by an educator in response to a student with an extenuating circumstance. Academic considerations are intended to minimize the impact of a serious or significant extenuating circumstance that is beyond a student’s control.

Considerations may include but are not limited to: an excused absence, a brief reprieve from coursework, extended or deferred deadline, a modified schedule for assignments, labs, placements, projects, or comprehensive exams, a deferred exam or project, a medical leave of absence, an alternate assignment, a re-weighting of assigned marks, course withdrawal without penalty, or other considerations deemed appropriate by a Faculty or School Office.

Academic considerations are determined based on a conversation between the student and their instructor. Students are advised to submit documentation and/or forms related to the Policy on Academic Considerations for Students in Extenuating Circumstances through the Faculty or School Office that is granting their degree.  Students are responsible for contacting their individual instructors to discuss academic considerations once documentation is processed. The final decision regarding the academic considerations are made by the course instructor.

Academic Accommodations

Academic accommodations are put in place to equalize learning opportunities and access to the academic environment for students with disabilities. A disability may include a temporary (e.g., a concussion, broken arm, or a sudden mental health crisis) or permanent (e.g., a learning disability, chronic health or mental heath issue) condition. The functional limitations resulting from a disability can at times intersect with the academic environment in a way that creates a barrier for students. Some examples of accommodations include extra time on exams, permission to use assistive technology for exams, or permission to audio record lectures.

Academic accommodations approved by Queen’s Student Accessibility Services (QSAS) are based on medical or other documentation, the student's reported personal experience with their disability, and the Queen’s Student Accessibility Services’ screening processes.

Quick Guide to Academic Considerations and Academic Accommodations click here.

Letter of Accommodation (LOA)

  • Completed by an Accessibility Services (QSAS) Advisor
  • Accommodations can be short-term or ongoing (date that accommodations expire will be specified on the form)

If this student requests an assignment extension or exam deferral for reasons of a disability for which they are accommodated via their LOA, please do not refer them to the Extenuating Circumstances Policy. Students are advised to email their instructor if they need an extension or deferral due to their disability, with a copy to their QSAS Advisor. If you have any questions or concerns in considering any requests, please contact the QSAS Advisor.

Short-Term Academic Consideration Form

  • Completed by a health care provider at Student Wellness Services
  • Provided if disability is expected to be temporary (up to one academic term) or if the student requires accommodations immediately while in the process of registering with Accessibility Services for ongoing accommodations 

If you have questions about the accommodations provided contact the QSAS Advisor for the LOA OR contact intake.wellness@queensu.ca or 613.533.6000 X 74842 to be connected with the provider that completed the STAC Form.

Paperwork for Students Requesting Academic Consideration

In most Faculties/Schools, students submit the Request for Academic Consideration for Extenuating Circumstances Form (with supporting documentation, if required) to an individual in the Faculty/School Office. The office will send an email to each instructor with additional information regarding the timeline of the request and impact on the student’s academic functioning. The student is responsible for following up with each instructor to discuss a plan for academic consideration.

What can I do if a student is requesting an exam deferral or assignment extension (i.e., academic consideration) because of an extenuating circumstance? 

If a student is requesting academic consideration (i.e., a deferral, extension, excused absence from class), advise the student to submit a Request for Academic Consideration for Extenuating Circumstance Form. If the student is requesting consideration for 3 days or less, they are not required to provide supporting documentation. However, some Faculties/Schools require students to provide documentation when submitting second and subsequent requests in a term for academic consideration lasting 3 days or less. Some Faculties/Schools may also require students to provide documentation for requests lasting 3 days or less that occur during midterms or final exams. Please refer to the specific procedures within your Faculty/School on page 3 of the Request for Academic Consideration for Extenuating Circumstances Form to determine if this process applies to your Faculty/School. In situations where documentation is not available (e.g., the student was at home and not seen by a health care provider), a Formal Attestation of Extenuating Circumstances Form signed by the student at the Faculty Office may be submitted. If the student is requesting consideration for more than 3 days, they will be asked to provide supporting documentation with their request.

A contact from the Faculty or School Office will accept the forms and/or documentation from the student and contact individual instructors with next steps. Each individual Faculty and School Office has a slightly different procedure. Please contact your individual Faculty or School Office for further details. Students are advised to submit documentation and/or forms related to the Policy on Academic Considerations for Students in Extenuating Circumstances through the Faculty or School Office that is granting their degree.

If the student is already registered with Queen’s Student Accessibility Services (QSAS) and are requesting an assignment extension or exam deferral for reasons of a disability for which they are accommodated via their Letter of Accommodation, please do NOT refer them to the Extenuating Circumstances Policy. For example, if a student discloses that they are registered with QSAS for Generalized Anxiety Disorder which has gotten significantly more debilitating. Please advise the student to email their course instructor with their request and copy their QSAS Advisor. If an instructor has any questions or concerns in considering these requests, they should contact the QSAS Advisor.

If you are unsure of how to direct the student, you can direct students to the Student Wellness Services website page Students with Extenuating Circumstances, refer the student to their Faculty/School Office  or refer the student to Student Wellness Services – phone 613.533.6000 X74842 or email intake.wellness@queensu.ca.

One of my students has used the “Request for Academic Consideration for Extenuating Circumstance” Form multiple times within a term without documentation (since the requests were for 3 days or less). Do I have to honour the request?

A student may have multiple extenuating circumstances throughout a term or academic year that warrants the need to use a Request for Academic Consideration for Extenuating Circumstances Form (without documentation) on more than one occasion. However, it is recommended that the instructor contact the student’s Faculty or School Office to determine the appropriate next steps, and ensure the student has the appropriate supports in place.

Some Faculties/Schools require students to provide documentation when submitting second and subsequent requests in a term for academic consideration lasting 3-days or less. Some Faculties/Schools may also require students to provide documentation for requests lasting 3-days or less that occur during midterms or final exams. In situations where documentation is not available (e.g., the student was at home and not seen by a health care provider), a Formal Attestation of Extenuating Circumstances Form signed at the Faculty Office may be submitted.

The Request for Academic Consideration for Extenuating Circumstance Form should be submitted in the interim, until the student is able to submit the Formal Attestation of Extenuating Circumstance Form. Please see Section F (page 3) of the Request for Academic Consideration for Extenuating Circumstance Form and/or consult your Faculty or School website for more information.

I have received an email from a student requesting academic consideration (e.g., extension on assignment, deferral of exam). The student has informed me that they are registered with Accessibility Services (QSAS). How is this request different from students with extenuating circumstances requesting academic consideration through the Extenuating Circumstances Policy? 

Students with ongoing disabilities or diagnosed health conditions that are registered with Accessibility Services (QSAS) may require additional support (e.g., extension on assignment, absence from class, deferral of an exam/test/quiz) related to their ongoing disability beyond their “Letter of Accommodations.” For example, a student with irritable bowel syndrome that is registered with QSAS has two days where their symptoms become significantly worse and inhibit their ability to complete a test or exam.

In these situations, students are instructed to contact their instructors and copy their Accessibility Services Advisor on the email to their instructors. The QSAS advisor will follow-up if the instructor has any questions or concerns. The student is NOT required to submit any documentation or forms from the Extenuating Circumstances Policy to support this request. The Accessibility Services Advisor will ensure the documentation on file at QSAS supports this request, and will follow-up with the instructor or student if they have any concerns.

One of my students submitted the Request for Academic Consideration for Extenuating Circumstances Form without documentation (i.e., 3 days or less) and is requesting academic consideration for an additional day. Do I have to honour the request or should I request supporting documentation?

Students are advised to submit a new Request for Academic Consideration for Extenuating Circumstances Form to their Faculty/School Office, and provide supporting documentation to extend their request beyond 3 days.

A student is requesting an academic consideration (e.g., assignment extension or exam deferral) for an extenuating circumstance (e.g., death of a family member). How do I know if the student’s extenuating circumstance is valid?

The “Academic Considerations for Students in Extenuating Circumstances” Policy is based on the principle of “good faith.” Thus, it is advised that instructors, Faculty Offices, and School Offices presume that all involved are acting with honest and sincere intentions. If you are concerned about the legitimacy of a request, you are welcome to consult with your Faculty or School Office. Students will submit a request for academic consideration to the Faculty/School Office that is granting their degree. The Faculty/School Office will review and verify the documentation provided (if required) and instructors will be advised of the expected duration of the student’s extenuating circumstance as well as the severity of the impact of this circumstance on the student’s ability to participate in academics.

How do I determine what academic considerations are appropriate based on the documentation provided from the Faculty/School Office? 

The documentation will likely outline whether a student is capable of completing any course work, and provides some idea as to the amount of course work a student can complete (i.e., can the student attend classes and complete assignments?). The instructor should begin by considering the student’s progress in the course, the course requirements, and the severity of the impact of the extenuating circumstance.

In the event the individual completing the documentation suggests a student will be unable to complete any course work for several weeks, an instructor may advise the student to follow-up with the Faculty or School Office to investigate options for course withdrawal without penalty. If the student is unable to complete any work for up to a week, the instructor may consider providing the student with an extension or deferral on any evaluations and allow the student to be absent from tutorials or labs, where possible. If a student has completed all of the course work thus far, but has a final exam to complete, the instructor may allow the student to delay the exam until the student is able to write, based on the anticipated resolution of the extenuating circumstance.

In the event there is uncertainty about the appropriate academic consideration, please connect with the contact within your Faculty or School Office for guidance (see below for list of contacts).

Note: You should NOT provide informal academic accommodations to a student based on documentation received through the Extenuating Circumstances Policy. If a student requests academic accommodations (e.g., extra time on an exam, separate room to write an exam, computer to write an exam), direct the student to the Intake Coordinator for Accessibility Services at 613.533.6000 X 77628 or qsas.intake@queensu.ca.

I have a student who is requesting an accommodation (e.g., extra time on exams, separate room to write exams) due to an extenuating circumstance (e.g., broken limb, concussion, bereavement). How should I advise the student? 

Advise the student to contact the administrative assistant for extenuating circumstances at intake.wellness@queensu.ca or 613.533.6000 X 74842.

Note: If a student is unable to meet academic obligations or requires ongoing academic accommodations due to functional limitations related to a known underlying disability or diagnosed health condition, please advise the student to contact Queen’s Student Accessibility Services to register for ongoing accommodations.

I want to include a statement in my course syllabus about requesting academic consideration. Is there a generic statement that I can include?

Please first refer to your Faculty/School Office for a statement regarding the Policy on Academic Consideration for Students with Extenuating Circumstances. If a statement is not available, you are welcome to use the following statement:

Queen’s University is committed to providing academic consideration to students experiencing extenuating circumstances that are beyond their control and which have a direct and substantial impact on their ability to meet essential academic requirements (e.g., death of a family member, short-term illness). If you have an extenuating circumstance during this course, please go here for additional information regarding how to submit a request for academic consideration.

How do I direct a student with an extenuating circumstance that is requesting additional physical or mental health support?

Find other supports and resources available on- and off-campus.

Contacts for Individual Faculty and School Offices

Faculty of Arts and Science

Lucy Mackrell
asc.consideration@queensu.ca
Faculty of Arts and Science (online portal for requests for academic consideration)

Faculty of Engineering and Applied Science

Catherine Gurnsey
engineering.aac@queensu.ca
(613) 533-6000 x 78013
Faculty of Engineering and Applied Science

Smith School of Business (Queen’s Commerce)

Angie Loyst
angie.loyst@queensu.ca
613.533.2324
Smith School of Business (go to the Commerce Portal for your program for additional information)

Faculty of Law

Helen Connop
helen.connop@queensu.ca
613.533.6000 X78147
Faculty of Law

School of Medicine

Dr. Richard Van Wylick
3wrcv@queensu.ca
School of Medicine

Faculty of Education

Stephanie Barnaby
stephanie.barnaby@queensu.ca
613.533.6000 X75476
Faculty of Education (if you are in concurrent-ed, contact your undergraduate faculty otherwise, contact the Associate Dean)

School of Rehabilitation Sciences

Occupational Therapy
Laurie Kerr
l.kerr@queensu.ca

Physical Therapy
Kathy Grant
grantk@queensu.ca

Bachelor of Health Sciences

Alana Korczynski
bhsc@queensu.ca
613.533.2566
Faculty of Health Sciences

School of Nursing

Barbara Bolton
boltonb@queensu.ca
613.533.6000 X74751
School of Nursing

Alternatively, you can phone 613.533.6000 X74842 or email intake.wellness@queensu.ca  to reach the administrative assistant for extenuating circumstances at Student Wellness Services. 

School of Graduate Studies

School of Graduate Studies


QSAS Documentation

Students who require academic accommodations can find additional information about accessibility documentation requirements and forms.


Transfer of Records   

To have your records sent to another physician/location or to obtain copies of your medical records please complete the Consent Regarding Personal Health Information form indicating specifically what you require (e.g., immunization record, entire chart, recent bloodwork) and drop it off at Student Health or send it by email to: sws.records@queensu.ca

Students can also obtain records in person without filling out a release of information by showing identification that has a picture at the SWS reception desk in Mitchell Hall.

There is a $40 fee for transferring records.

If you have questions related to the transfer of your records, please contact:
Phone: 613-533-6000 x 74509
Email: sws.records@queensu.ca