Religious Observance Form 11 11 11 Form Only Final by H9ogoZc

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									                                 RELIGIOUS OBSERVANCE FORM
Walden University embodies a culturally and spiritually diverse community, and recognizes that, on occasion,
certain members will observe practices that preclude them from attending to their regular duties. Students who
are unable to participate fully in an Academic Residency on a particular day during the calendared residency
dates for reasons of religious observance (e.g., Sabbath, Friday Prayers) must complete this Religious
Observance Form and return it to Academic Residencies within 3 weeks of the start of the residency.

Policy: If you have religious traditions that may conflict with the requirements of the academic residency (i.e.,
missing a day of residency), you are required to attend an additional residency to make up for the day(s) missed.
There is no charge for the additional residency itself; however, you will be responsible for any associated lodging
and travel costs to and for the additional residency site. We also ask that you contact the Academic Residencies
Team at academicresidencies@waldenu.edu at least 2 months in advance of the residency to discuss
accommodations.

Option: Walden University makes every effort to provide options for Religious Observation for its students. To
avoid possible scheduling conflicts, students are encouraged to review the residency calendar carefully. Please
note that residency options during July and December are scheduled during weekdays and would create
minimum conflict.


STUDENT ID NUMBER                                         DATE SUBMITTED

                                                          M                   D                   Y

FULL NAME                                                 PROGRAM



WALDEN E-MAIL ADDRESS                                     PROGRAM DIRECTOR’S NAME:



TERM OF ACCOMMODATION REQUESTED:                          COURSE AND SECTION:
Circle one: Semester/ Quarter
            Fall Winter Spring Summer




                            ACCOMMODATION FOR OBSERVANCE DURING THE RESIDENCY
DATE OF CONFLICT     OBSERVANCE                 REQUESTED ACCOMMODATION           AGREED-UPON ACCOMMODATION




             PROTECTION OF PRIVACY:
             The information on this form is collected under the authority of the Walden University
             Privacy Act and is needed to process your application for Academic Consideration. The
             information will be used in connection with this application.
It is understood that this information will be treated in a confidential manner, except to the extent that the
information is false, fraudulent, is required to be used in any claim of academic misconduct against the student,
or is required to be disclosed to defend WALDEN in any claim or potential claim involving the student or the
suspicion of fraud.
STUDENT SIGNATURE                                                                 DATE




Authorization by Program Director:
I support the above student’s request to accommodate the dates/times indicated for reason of religious
observation.
PROGRAM DIRECTOR SIGNATURE                                                        DATE




RESIDENCY ADMINISTRATOR SIGNATURE                                                 DATE

								
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