Accessible Learning Registration Form

Questions

1.  

   Please select the following statements that apply to you; I am a/an:

   Undergraduate Student

   Graduate/Post-Graduate Student

   Transfer student from another university or college

   International student studying on a student visa

   Double degree student with Laurier and the University of Waterloo

   University of Waterloo student cross-registered in a course at Laurier

   Taking a course at Laurier through a Letter of Permission from another university

   Additional Note or Comment
2.  

   Have you registered with Accessible Learning before? * (Selection is Required)

   Yes

   No

   Additional Note or Comment
3. Use this space to tell us about your learning and access needs.
4. If you have received academic accommodations in the past, please list them here.
5.  

   What supports are you interested in speaking with Accessible Learning about? Please check all that apply.

   Academic Accommodations

   Disability Assessment Information

   Learning Strategy Support

   Assistive Technology

   Bursary Funding

   Additional Services

   Other

   Additional Note or Comment
6.  

   Can Accessible Learning staff leave confidential voicemails at the phone number you have provided? * (Selection is Required)

   Yes

   No

   Additional Note or Comment
7.  

   Please confirm you have read the following statements by checking EACH of the boxes below.

   I understand that the information collected through this form and supporting documentation is held in the strictest confidence, in accordance the Statement of Confidentiality for Accessible Learning.

   I give consent for Accessible Learning to contact the health care professionals listed on any submitted documentation to clarify information provided in the documentation, including (a) confirming whether or not I have a disability, (b) details about my disability-related functional limitations and/or; (c) details about my access needs. I understand that this contact is restricted to clarifying information in my documentation to better inform academic accommodations and to support planning.

   I authorize the health care professionals listed on any submitted documentation to clarify information with Accessible Learning at Wilfrid Laurier University that has been provided in my documentation about my disability and disability-related functional limitations for the purposes of informing academic accommodations and to support planning.

   Additional Note or Comment
8.  

   Your registration with Accessible Learning cannot be completed until you submit supporting disability document. Tell us when you will submit your documentation: Documentation Guidelines

   I will upload my documentation now.

   I will upload my documentation later.

   I currently do not have documentation. Note: If you do not have documentation, an Intake Coordinator will contact you about next steps.

   Additional Note or Comment