New Student Intake Form

* indicates a required field

Student Information

Important: If you are seeking support for a mental health concern and you are not currently working with a health care professional in this regard, please meet with a Student Wellness Navigator before proceeding. You can book an appointment by contacting our front desk at 519-824-4120 ext. 52131. Appointments are usually available within a day or two and will help to connect you with the most appropriate resources and support services.

General information: This form is used to help determine whether Student Accessibility Services (SAS) is the right service for you, and when appropriate, help connect you with an SAS advisor.

SAS only supports students who been admitted to the University of Guelph through Admission Services or Graduate Studies and who have a disability. If you have registered for courses through Open Learning and Educational Support (OpenEd) and are not currently enrolled in a degree program at Guelph, please contact the Academic Assistant to the Executive Director for academic accommodations.

For University of Guelph-Humber, please contact Accessible Learning Services at Humber College. Local services are also available through SAS at the Ridgetown campus.

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A short form or alternate name you prefer people use when addressing you.
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This is a 7-digit number and starts with 0 or 1
Pronouns(Required) *




Date of Birth(Required) *
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Please use your UofG e-mail address
OSAP
Are you eligible for OSAP?



Degree Level





+1-519-555-1234
+1-519-555-1234

Local Address

Residence
Are you living in an on-campus residence this year?

Permanent Address

Where you live when not at university.
Canada

Disability Information

We acknowledge that the term "disability" makes some people uncomfortable and we use it specifically with regards to protecting your rights and connecting you with the appropriate resources. You have many strengths and abilities!
Confirmed by healthcare professional(Required) *
Has a health care professional provided you with a diagnosis related to your disability?
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Please indicate the disability you experience that has the greatest impact on your learning.
If you experience additional disabilities, please indicate them here.
[select]
Hospital or emergency care(Required) *
Have you recently been in the hospital or received emergency care related to your disability?

Academic Standing

Student Status(Required) *
Please choose one of the following statements



Absence from school(Required) *
Have you recently experienced an absence of 2 weeks or more from school for disability-related reasons?
Academic Deadline(Required) *
Do you have a pressing academic concern that requires attention in the near future?
Previous semesters(Required) *
Have you failed courses or are you on academic probation as a result of your disability?
Outstanding courses(Required) *
Do you have any deferred exams or incomplete coursework from a previous semester?

Resources

Accommodations Prior to UofG(Required) *
Did you receive accommodations in high school or at another post-secondary institution?
Counselling at UofG(Required) *
Have you used Counselling Services at the U of G in relation to your disability?
Health Services at UofG(Required) *
Have you used Health Services at the U of G in relation to your disability?
Coordinating Services(Required) *

Student Accessibility Services (SAS) is a part of a larger department called Student Wellness and while SAS maintains separate student files, relevant information may be shared between units for the purposes of coordinating services (e.g. with Counselling Services and Health Services). I grant permission for professionals involved in my care to give and receive information for this purpose.

Note: this permission can be revoked at any time by contacting SAS in writing.

Current Functioning

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Please give a brief description of your disability and how it impacts your learning or daily living at university.
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What are your academic concerns related to your disability?
If this is a temporary situation, what is the expected duration?

Documentation

To protect the integrity of a rigorous academic environment, we require documentation verifying the existence of a disability from a registered health professional who is authorized to make a relevant diagnosis. Please visit our documentation guidelines for full details.

Documentation Available?(Required) *