Lifetime Activities - CU (Air Quality: Request for Accommodation)

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This form is used to request an accommodation (make up) for classes that run when the AQI is at ORANGE (101-150). Please note that this form is for individual use on a class by class basis. Please fill out a new form for each family member if there are multiple students in the same program. This form must be submitted no later than the class start time on the day your program is impacted by AQI in order to be considered.

Email *

Last Name *

First Name *

Phone Number *

Date of Class Affected by AQI *

YYYY

Class Name *

Class Day *

Class Start Time *

Time

Reason for Accommodation Request *

Full Name of Parent / Guardian if the student is a minor

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