The Concussion Academic Modification Form is a structured tool designed to help schools provide appropriate support to students recovering from a concussion. After a concussion, the brain needs time to heal—not only from physical activity but also from cognitive exertion. Academic demands such as reading, writing, computer use, test-taking, and concentrating for long periods can significantly worsen symptoms and delay recovery if not appropriately managed. This form facilitates communication between healthcare providers, school staff, parents, and students to ensure a safe and supported return to learning.

This form outlines common post-concussion symptoms that may interfere with academic performance and identifies a range of temporary accommodations that can be customized based on each student's needs. These may include schedule adjustments (like shortened days or rest breaks), reduced cognitive load, modified homework and test expectations, screen time restrictions, and environmental adaptations such as wearing sunglasses or avoiding noisy settings.

By clearly identifying the symptoms a student is experiencing and the specific supports they require, this form helps school teams implement effective, individualized plans. It also provides a timeline for reassessment and ongoing support, ensuring that modifications remain appropriate as the student progresses through recovery.

The goal is to promote healing while minimizing academic stress, protecting the student’s well-being without compromising their educational progress. This tool is particularly helpful for teachers, school nurses, counselors, and administrators who may not be familiar with concussion management but want to provide safe and supportive learning environments.

This form can be completed by a licensed healthcare provider, school medical staff, or other qualified professionals, and should be reviewed regularly until the student is symptom-free and fully reintegrated into normal academic activities.