- Title IX Office

Academic Supportive Measure(s) Request Form

This form is designed to help the Title IX Office at Marshall University understand your concerns and provide appropriate support. Completing this form allows us to: Offer supportive measures to ensure your safety and access to education and Connect you with campus and community resources. You are not required to file a formal complaint to request supportive measures. The information you share will be handled with sensitivity and in accordance with university policy. If you have questions or need assistance, please contact the Title IX Coordinator at titleix@marshall.edu or 304-696-2467. Note: All requests must be specific, temporary, and directly related to a Title IX incident or process. Requests that are better suited for other offices (e.g., Accessibility, Counseling, Student Affairs) may be referred accordingly.

Supportive measures are non-disciplinary, non-punitive services provided to ensure equal access to education. They may include assignment extensions, excused absences, or exam rescheduling. All measures must be reasonable and cannot override academic decisions made by instructors or departments. The Title IX Office facilitates these measures but does not alter grading policies or academic standards.

Please use this form to request Academic Supportive Measure(s) from the Title IX Office.

REMINDER: SUBMIT A SEPARATE REQUEST FORM FOR EACH COURSE YOU ARE REQUESTING ACADEMIC SUPPORTIVE MEASURE(S) FOR. Failure to submit a separate Request Form for each course can result in delays and a request to submit a separate Request Form.

IMPORTANT NOTICE: Students are encouraged to submit requests for academic supportive measures within two weeks of recognizing the need, when feasible. We understand that some situations—such as medical emergencies or evolving personal circumstances—may arise unexpectedly. In such cases, requests submitted outside this timeframe will still be reviewed on a case-by-case basis. Please note that requests made late in the semester, particularly when the need was known earlier, may be denied. Submitting requests in a timely manner helps ensure we can provide the most effective support and accommodations.

Examples of Documentation or Valid Reasons for Late Requests: 1. Mental Health Documentation: A letter from a licensed mental health provider indicating the student was experiencing trauma-related symptoms (e.g., PTSD, anxiety, depression) that delayed their ability to seek help or disclose the incident. 2. Medical Records: Documentation of medical treatment related to the incident (e.g., ER visit, sexual assault forensic exam) that impacted the student’s ability to request support in a timely manner. 3. Police or Legal Involvement: A police report, protective order, or legal documentation showing the student was involved in an investigation or court process that caused emotional or logistical delays. 4. Campus Safety Concerns: A report to campus security or a safety plan indicating the student prioritized immediate safety (e.g., housing change, no-contact order) before addressing academic needs. 5. Delayed Disclosure Due to Trauma or Fear: A personal statement or advocate’s note explaining the student did not initially feel safe or ready to disclose the harassment and only recently felt able to come forward. 6. Support from an Advocate: A statement from a campus or community victim advocate confirming the student was receiving support and that the delay was due to trauma, fear of retaliation, or uncertainty about available resources. 7. Faculty or Staff Referral: Documentation that a faculty or staff member referred the student to the Title IX Office after noticing signs of distress or academic decline. 8. Academic Impact Statement: A written explanation from the student describing how the harassment affected their academic performance and why they delayed seeking accommodations. 9. Documentation Delays: The student was waiting on medical, legal, or counseling documentation and submitted the request as soon as it became available. ⚠️ Important Note on Integrity: Knowingly providing false information to the Title IX Office may constitute a violation of the Student Code of Conduct and could result in disciplinary action.

Examples of Timely Submission 1. Submitting a request for exam accommodations at the beginning of the semester or as soon as the need becomes known. 2. Requesting extensions or modifications to assignment deadlines promptly after experiencing a significant event or change in circumstances. 3. Notifying the Title IX Office of any issues affecting your academic performance as soon as they arise, rather than waiting until the end of the semester. Consequences of Late Requests 1. Late requests may not be accommodated if there is insufficient time to implement the necessary measures. 2. Delayed submissions could result in denial of the request, which may negatively impact your academic performance and progress. 3. Requests submitted late in the semester may limit the available options and resources to support you effectively. If you have questions or need assistance, please contact the Title IX Office at titleix@marshall.edu.

PLEASE NOTE: It is important that you maintain direct communication with your professor(s) regarding your academic situation, as our role is solely to assist in facilitating the implementation of supportive measures.

Information about You

Your Name(Required)

First Last

Student ID Number(Required)

Provide your 901/903 Number

Preferred Name / Pronouns(Required)

List your preferred name and pronouns.

Preferred Method of Contact

Your Email Address(Required)

Email Address Confirm Email Address

Your Phone(Required)

Course Information

Request for Information regarding course. REMINDER: SUBMIT A SEPARATE REQUEST FORM FOR EACH COURSE YOU ARE REQUESTING ACADEMIC SUPPORTIVE MEASURE(S) FOR. Failure to submit a separate Request Form for each course can result in delays and a request to submit a separate Request Form.

Is this request directly related to your participation in a Title IX process (e.g., as a Complainant or Respondent)?(Required)

Yes

If yes, briefly explain how the request relates to your Title IX involvement:

Term(Required)

List semester/term of course for which you are requesting supportive measures.

Course Year(Required)

List the year of the course you are requesting supportive measures. Please note, old courses/grades cannot usually be adjusted.

Course Title(Required)

List the Full Title for the Course

Course Code(Required)

List the Course Code. Ex. ENG101.

Meets(Required)

Day(s) and Time of Course

Location(s) of Course(Required)

Primary Instructor Name(Required)

Primary Instructor Email(Required)

Secondary Instructor Name

Secondary Instructor Email

Description of Supportive Measure(s) You Are Requesting

Please describe the description/detail of the supportive measure(s) you request (i.e., assignment extensions, excused absences, etc.) Examples: 1. State the specific dates for which you need supportive measure, and if you need extensions of time to turn in the assignments, state the name of the assignment, the due date, and the proposed deadline. 2. Please provide information regarding how you would like to submit the assignment. 3. If the assignment is submitted online, does the professor need to reopen a module or online submission page to allow you to submit it? 4. If you are requesting to retake an exam, please provide the dates you are available to take the exam. 5. If you are requesting to makeup a presentation, please state when and where you would like to do the presentation. 6. If you are requesting an excused absence, list the specific dates you are requesting for excused absences. While the Title IX Office is responsible for requesting the supportive measure, we encourage you to speak with your professors to determine the best way to provide the supportive measure.

Description/Detail of the supportive measure(s) you request(Required)

Assignment Extension(s)

Presentation Extension(s)

Test/Exam Extension(s)

Excused Absence(s)

Other

Assignment Extension(s). 1. State the specific dates you need extensions of time to turn in the assignments, state the name of the assignment, the due date, and the proposed deadline. 2. Please provide information regarding how you would like to submit the assignment. 3. If the assignment is submitted online, does the professor need to reopen a module or online submission page to allow you to submit it? 4. If you are requesting to makeup a presentation, please state when and where you would like to do the presentation. While the Title IX Office is responsible for requesting the supportive measure, we encourage you to speak with your professors to determine the best way to provide the supportive measure. If this does not apply to you, enter N/A.(Required)

Presentation Extension(s). 1. State the specific dates you need extensions of time to submit a presentation, state the name of the presentation, the due date, and the proposed deadline. 2. Please provide information regarding how you would like to submit the presentation. 3. If the presentation is submitted online, does the professor need to reopen a module or online submission page to allow you to submit it? 4. If you are requesting to makeup a presentation, please state when and where you would like to do the presentation. While the Title IX Office is responsible for requesting the supportive measure, we encourage you to speak with your professors to determine the best way to provide the supportive measure. If this does not apply to you, enter N/A.(Required)

Test/Exam Extension(s). 1. State the specific dates that the test/exam was held on, and state the name of the test/exam. 2. If you are requesting to retake an exam, please provide the dates you are available to take the exam. take the test. 2. Please provide information regarding how you would like to retake the test/exam. 3. If the test/exam is submitted online, does the professor need to reopen a module or online submission page to allow you to submit it? 4. If you are requesting to makeup a test/exam, please state when and where you would like to do the test/exam. While the Title IX Office is responsible for requesting the supportive measure, we encourage you to speak with your professors to determine the best way to provide the supportive measure. If this does not apply to you, enter N/A.(Required)

Excused Absence(s). If you are requesting an excused absence, list the specific dates you are requesting for excused absences. While the Title IX Office is responsible for requesting the supportive measure, we encourage you to speak with your professors to determine the best way to provide the supportive measure. If this does not apply to you, enter N/A.(Required)

Other. Specify what you are requesting, including the specific dates you are requesting for the other supportive measure(s) and if you extensions of time regarding the other supportive measure(s), state the name of the other supportive measure(s), the due date, and the proposed deadline. 2. Please provide information regarding how you would like to submit the other supportive measure(s). 3. If the other supportive measure(s) is submitted online, does the professor need to reopen a module or online submission page to allow you to submit it? 4. If you are requesting to retake the other supportive measure(s), please provide the dates you are available to take the other supportive measure(s). 5. If you are requesting to makeup the other supportive measure(s), please state when and where you would like to do the other supportive measure(s). While the Title IX Office is responsible for requesting the supportive measure, we encourage you to speak with your professors to determine the best way to provide the supportive measure. If this does not apply to you, enter N/A.(Required)

Do you currently have an internship, Field Placement, or Practicum Site?(Required)

If Yes, please provide the following: Name of Placement Site, Site Supervisor Name, and Site Supervisor Email. Use N/A if this does not apply to you.(Required)

Once you register with our office, would you like us to contact your instructor(s) on your behalf?(Required)

CAPTCHA

Thank you for taking the time to fill out the Academic Supportive Measure(s) Request Form. A member of the Title IX Office will be in touch with you shortly.

REMINDER: Submit a separate Request Form for each course in which you are requesting academic supportive measures. Failure to do so may result in delays and a request to resubmit using separate forms. PLEASE NOTE: While the Title IX Office facilitates the request for supportive measures, it is the student's responsibility to follow up with each professor to ensure the measures are implemented. We encourage you to maintain open and ongoing communication with your instructors regarding your academic needs.

IMPORTANT NOTICE REMINDER: Students are encouraged to submit requests for academic supportive measures within two weeks of recognizing the need, when feasible. We understand that some situations—such as medical emergencies or evolving personal circumstances—may arise unexpectedly. In such cases, requests submitted outside this timeframe will still be reviewed on a case-by-case basis. Please note that requests made late in the semester, particularly when the need was known earlier, may be denied. Submitting requests in a timely manner helps ensure we can provide the most effective support and accommodations.

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