{"id":1005,"date":"2024-05-22T13:26:34","date_gmt":"2024-05-22T13:26:34","guid":{"rendered":"https:\/\/www.marshall.edu\/titleix\/?page_id=1005"},"modified":"2024-05-22T13:29:47","modified_gmt":"2024-05-22T13:29:47","slug":"academic-supportive-measures-request-form","status":"publish","type":"page","link":"https:\/\/www.marshall.edu\/titleix\/academic-supportive-measures-request-form\/","title":{"rendered":""},"content":{"rendered":"<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_4' style='display:none'>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Academic Supportive Measures Request Form<\/h2>\n                            <p class='gform_description'>Marshall University \u2013 Title IX Office\r\nSupportive measures are non\u2011disciplinary, non\u2011punitive steps designed to help you maintain access to your education.\r\n\r\nNote: 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.<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_4'  action='\/titleix\/wp-json\/wp\/v2\/pages\/1005' data-formid='4' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_4' class='gform_fields top_label form_sublabel_above description_below validation_below'><div id=\"field_4_52\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Supportive measures are non\u2011disciplinary, non\u2011punitive services designed to help ensure you have equal access to your education. These may include assignment extensions, excused absences, or exam rescheduling. All supportive measures must be reasonable and cannot override academic decisions made by instructors or departments. The Title IX Office facilitates these measures but does not change grading policies or academic standards.<\/h3><\/div><div id=\"field_4_64\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Please use this form to request Academic Supportive Measure(s) from the Title IX Office.<\/h3><div class='gsection_description' id='gfield_description_4_64'>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.                                          <\/div><\/div><div id=\"field_4_61\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Examples of Acceptable Reasons for Late Supportive Measure Requests<\/h3><div class='gsection_description' id='gfield_description_4_61'>Students may submit requests outside the preferred two\u2011week window for many reasons. Common examples include:\n\n\nMental Health or Trauma Impact\nDocumentation from a mental health provider showing trauma\u2011related symptoms (such as anxiety, depression, or PTSD) that delayed the student\u2019s ability to seek support.\n\n\nMedical Treatment\nRecords of medical care related to the incident (e.g., ER visit, medical evaluation) that affected the student\u2019s ability to request help sooner.\n\n\nPolice or Legal Processes\nA police report, protective order, or other legal involvement that caused emotional, safety\u2011related, or logistical delays.\n\n\nSafety Concerns\nEvidence that the student prioritized immediate safety needs (such as a housing change or a no\u2011contact order) before academic matters.\n\n\nDelayed Disclosure Due to Trauma\nA personal statement or advocate\u2019s note explaining that the student did not feel safe or ready to disclose the incident earlier.\n\n\nAdvocate Support\nA note from a campus or community advocate confirming the delay was related to trauma, fear of retaliation, or uncertainty about available options.\n\n\nReferral From Faculty or Staff\nDocumentation showing a faculty or staff member referred the student after noticing distress or changes in academic performance.\n\n\nStudent Impact Statement\nA written explanation from the student describing how the incident affected their academics and contributed to the delay.\n\n\nDelayed Documentation\nThe student was waiting for medical, legal, or counseling documents and submitted the request as soon as they received them.<\/div><\/div><div id=\"field_4_73\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Integrity Reminder<\/h3><div class='gsection_description' id='gfield_description_4_73'>Knowingly providing false information to the Title IX Office may violate the Student Code of Conduct.<\/div><\/div><div id=\"field_4_62\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Examples of Timely Requests &amp; Important Notes About Late Submissions<\/h3><div class='gsection_description' id='gfield_description_4_62'>Examples of Timely Submission\nStudents are encouraged to submit requests as soon as they recognize a need. Examples of timely submissions include:\n\nRequesting exam or test accommodations early in the semester or as soon as you become aware of a conflict or need.\nAsking for assignment extensions promptly after experiencing a significant event or a change in circumstances.\nNotifying the Title IX Office of academic concerns as they arise, rather than waiting until the end of the semester.\n\n\nConsequences of Late Requests\nWe understand that life circumstances vary, and we will review all requests. However, please note:\n\nLate requests may not be possible to accommodate if there is not enough time left in the semester to implement the measures.\nA delayed request may be denied, which can affect your academic progress.\nSubmitting a request late in the semester limits available options, and faculty flexibility may be reduced.\n\nIf you have questions or need support, please contact the Title IX Office at titleix@marshall.edu.<\/div><\/div><div id=\"field_4_68\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Reminder: Continue Communicating With Your Instructor(s)<\/h3><div class='gsection_description' id='gfield_description_4_68'>PLEASE NOTE:\nIt is important that you continue communicating directly with your professor(s) about your academic needs. The Title IX Office\u2019s role is to help facilitate supportive measures, but your ongoing communication with your instructor(s) ensures those measures can be implemented effectively.<\/div><\/div><div id=\"field_4_7\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Student Information<\/h3><\/div><fieldset id=\"field_4_1\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Your Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_4_1'>\n                            \n                            <span id='input_4_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_4_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                    <input type='text' name='input_1.3' id='input_4_1_3' value=''   aria-required='true'    autocomplete=\"given-name\" \/>\n                                                <\/span>\n                            \n                            <span id='input_4_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_4_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                            <input type='text' name='input_1.6' id='input_4_1_6' value=''   aria-required='true'    autocomplete=\"family-name\" \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_4_18\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible text-input\"  data-field-class=\"text-input\" ><label class='gfield_label gform-field-label' for='input_4_18'>Student ID Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_18'>Provide your 901\/903 Number<\/div><div class='ginput_container ginput_container_text'><input name='input_18' id='input_4_18' type='text' value='' class='large'  aria-describedby=\"gfield_description_4_18\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_19\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible text-input\"  data-field-class=\"text-input\" ><label class='gfield_label gform-field-label' for='input_4_19'>Preferred Name \/ Pronouns<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_19'>List your preferred name and pronouns.<\/div><div class='ginput_container ginput_container_text'><input name='input_19' id='input_4_19' type='text' value='' class='large'  aria-describedby=\"gfield_description_4_19\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_11\" class=\"gfield gfield--type-select gfield--input-type-select field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_11'>Preferred Method of Contact<\/label><div class='ginput_container ginput_container_select'><select name='input_11' id='input_4_11' class='medium gfield_select'     aria-invalid=\"false\" ><option value='Email' >Email<\/option><option value='Phone' >Phone<\/option><\/select><\/div><\/div><fieldset id=\"field_4_2\" class=\"gfield gfield--type-email gfield--input-type-email gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Your Email Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_4_2_container'>\n                                <span id='input_4_2_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <label for='input_4_2' class='gform-field-label gform-field-label--type-sub '>Email Address<\/label>\n                                    <input class='' type='email' name='input_2' id='input_4_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  autocomplete=\"email\"\/>\n                                <\/span>\n                                <span id='input_4_2_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <label for='input_4_2_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email Address<\/label>\n                                    <input class='' type='email' name='input_2_2' id='input_4_2_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  autocomplete=\"email\"\/>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><div id=\"field_4_5\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_5'>Your Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_5' id='input_4_5' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"  autocomplete=\"tel\" \/><\/div><\/div><fieldset id=\"field_4_66\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Title IX Connection<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_4_66'>Is this request related to a Title IX incident or process?<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_4_66'><div class='gchoice gchoice_4_66_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_66.1' type='checkbox'  value='Yes'  id='choice_4_66_1'   aria-describedby=\"gfield_description_4_66\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_4_66_1' id='label_4_66_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_66_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_66.2' type='checkbox'  value='No'  id='choice_4_66_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_66_2' id='label_4_66_2' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_71\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible text-input\"  data-field-class=\"text-input\" ><label class='gfield_label gform-field-label' for='input_4_71'>Briefly explain how your request relates to a Title IX incident or process.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_71' id='input_4_71' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_8\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Course Information<\/h3><div class='gsection_description' id='gfield_description_4_8'>Please submit a separate request form for each course in which you are seeking academic supportive measures. Submitting multiple courses on one form may cause delays and require resubmission.<\/div><\/div><div id=\"field_4_26\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_26'>Term<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_26'>List semester\/term of course for which you are requesting supportive measures.<\/div><div class='ginput_container ginput_container_select'><select name='input_26' id='input_4_26' class='large gfield_select'  aria-describedby=\"gfield_description_4_26\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='Fall' >Fall<\/option><option value='Spring' >Spring<\/option><option value='Summer' >Summer<\/option><\/select><\/div><\/div><div id=\"field_4_30\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible text-input\"  data-field-class=\"text-input\" ><label class='gfield_label gform-field-label' for='input_4_30'>Course Year<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_30'>List the year of the course you are requesting supportive measures. Please note, old courses\/grades cannot usually be adjusted. <\/div><div class='ginput_container ginput_container_text'><input name='input_30' id='input_4_30' type='text' value='' class='large'  aria-describedby=\"gfield_description_4_30\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_31\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible text-input\"  data-field-class=\"text-input\" ><label class='gfield_label gform-field-label' for='input_4_31'>Course Title<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_31'>List the Full Title for the Course<\/div><div class='ginput_container ginput_container_text'><input name='input_31' id='input_4_31' type='text' value='' class='large'  aria-describedby=\"gfield_description_4_31\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_28\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible text-input\"  data-field-class=\"text-input\" ><label class='gfield_label gform-field-label' for='input_4_28'>Course Code<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_28'>List the Course Code. Ex. MTH 127.<\/div><div class='ginput_container ginput_container_text'><input name='input_28' id='input_4_28' type='text' value='' class='large'  aria-describedby=\"gfield_description_4_28\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_36\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible text-input\"  data-field-class=\"text-input\" ><label class='gfield_label gform-field-label' for='input_4_36'>Meets<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_36'>Day(s) and Time of Course<\/div><div class='ginput_container ginput_container_text'><input name='input_36' id='input_4_36' type='text' value='' class='large'  aria-describedby=\"gfield_description_4_36\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_37\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible text-input\"  data-field-class=\"text-input\" ><label class='gfield_label gform-field-label' for='input_4_37'>Location(s) of Course<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_37' id='input_4_37' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_32\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible text-input\"  data-field-class=\"text-input\" ><label class='gfield_label gform-field-label' for='input_4_32'>Primary Instructor Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_32' id='input_4_32' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_33\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible text-input\"  data-field-class=\"text-input\" ><label class='gfield_label gform-field-label' for='input_4_33'>Primary Instructor Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_33' id='input_4_33' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_34\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible text-input\"  data-field-class=\"text-input\" ><label class='gfield_label gform-field-label' for='input_4_34'>Secondary Instructor Name<\/label><div class='ginput_container ginput_container_text'><input name='input_34' id='input_4_34' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_35\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible text-input\"  data-field-class=\"text-input\" ><label class='gfield_label gform-field-label' for='input_4_35'>Secondary Instructor Email<\/label><div class='ginput_container ginput_container_text'><input name='input_35' id='input_4_35' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_4_53\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Description of Supportive Measure(s) You Are Requesting<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_4_53'>Check all that apply:<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_4_53'><div class='gchoice gchoice_4_53_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_53.1' type='checkbox'  value='Assignment Extension(s)'  id='choice_4_53_1'   aria-describedby=\"gfield_description_4_53\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_4_53_1' id='label_4_53_1' class='gform-field-label gform-field-label--type-inline'>Assignment Extension(s)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_53_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_53.2' type='checkbox'  value='Exam\/Test Extension(s)'  id='choice_4_53_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_53_2' id='label_4_53_2' class='gform-field-label gform-field-label--type-inline'>Exam\/Test Extension(s)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_53_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_53.3' type='checkbox'  value='Excused Absence(s)'  id='choice_4_53_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_53_3' id='label_4_53_3' class='gform-field-label gform-field-label--type-inline'>Excused Absence(s)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_53_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_53.4' type='checkbox'  value='Presentation Extension(s)'  id='choice_4_53_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_53_4' id='label_4_53_4' class='gform-field-label gform-field-label--type-inline'>Presentation Extension(s)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_53_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_53.5' type='checkbox'  value='Other (describe below)'  id='choice_4_53_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_53_5' id='label_4_53_5' class='gform-field-label gform-field-label--type-inline'>Other (describe below)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_54\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_54'>Describe what you are requesting. If you selected more than one supportive measure above, please provide information for each measure you are requesting. To help us communicate clearly with your instructor(s), include details such as:  The specific supportive measure(s) you are requesting (e.g., assignment extension, exam make\u2011up, excused absences, presentation extension, etc.). Specific dates involved (e.g., absence dates, assignment deadlines, exam dates). The name of the assignment\/test\/presentation, the original due date, and your proposed new deadline. How you plan to submit the assignment or complete missed work. Whether your instructor will need to reopen an online module or submission portal. For presentations: when and where you are available to make it up.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_54' id='input_4_54' class='textarea large'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_4_72\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_72'>Additional Information (Optional)<\/label><div class='gfield_description' id='gfield_description_4_72'>Is there anything else you want the Title IX Office to know?<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_72' id='input_4_72' class='textarea large'  aria-describedby=\"gfield_description_4_72\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_4_47\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_47'>Instructor Notification<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_47'>Would you like the Title IX Office to contact your instructor(s) on your behalf?<\/div><div class='ginput_container ginput_container_select'><select name='input_47' id='input_4_47' class='large gfield_select'  aria-describedby=\"gfield_description_4_47\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/div><div id=\"field_4_49\" class=\"gfield gfield--type-captcha gfield--input-type-captcha gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_49'>CAPTCHA<\/label><div id='input_4_49' class='ginput_container ginput_recaptcha' data-sitekey='6LcJtEQiAAAAAP_vuQ362iVBQS2x9xrCp_cm3msg'  data-theme='light' data-tabindex='0'  data-badge=''><\/div><\/div><fieldset id=\"field_4_48\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Certification<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_48.1' id='input_4_48_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_4_48_1' >I certify that I am the student submitting this request and that the information provided is accurate. I understand that supportive measures are temporary and must not fundamentally alter academic programs or place undue burden on the university.<\/label><input type='hidden' name='input_48.2' value='I certify that I am the student submitting this request and that the information provided is accurate. I understand that supportive measures are temporary and must not fundamentally alter academic programs or place undue burden on the university.' class='gform_hidden' \/><input type='hidden' name='input_48.3' value='2' class='gform_hidden' \/><\/div><\/fieldset><div id=\"field_4_51\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Thank you for completing the Academic Supportive Measure(s) Request Form. A member of the Title IX Office will review your submission and contact you shortly.<\/h3><div class='gsection_description' id='gfield_description_4_51'>Reminder: Please submit a separate form for each course in which you are requesting academic supportive measures. Submitting multiple courses on one form may cause delays and require resubmission.\nPlease note: The Title IX Office helps facilitate supportive measures, but it is the student\u2019s responsibility to follow up with each professor to ensure the measures are implemented. We encourage you to maintain open, ongoing communication with your instructors about your academic needs.<\/div><\/div><div id=\"field_4_63\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">IMPORTANT TIMING REMINDER<\/h3><div class='gsection_description' id='gfield_description_4_63'>Students are encouraged to submit requests for academic supportive measures within two weeks of recognizing the need, when possible. We understand that unexpected situations\u2014such as medical, safety\u2011related, or personal circumstances\u2014can arise. If this happens, we will still review your request on a case\u2011by\u2011case basis.\nPlease note that requests made late in the semester, especially when the need was known earlier, may be more difficult to implement and may be denied. 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