Student Academic Accommodation Request Form

Student Information

Please enter your information

First or Preferred Name

Last Name

Student ID or Birthday (year-month-day eg 2001-08-27)

Email

Please use your college issued email address

Phone Number

Program Name:

Program start date:

Program end date:

My diagnosed disability falls into the following category

If Other, please describe:

How does your disability affect you academically?

Have you previously had accommodations in an academic setting?

If you have any of the following documentation, you can provide it now to help us prepare for the meeting.

Documentation to support an accommodation request for your disability and/or diverse ability may include:

1. Provide us with a previous psycho-educational report, assessment and/or IEP

2. OR: Book an appointment with your family doctor (or any doctor)

- Return the form to your Accessibility Services Coordinator by uploading it below.

If you need additional time to have your doctor complete this form, you can upload it later to your Accommodate Portal.

Upload supporting document(s)