Student Accommodation Request Form

* indicates a required field

Student Information

Alberta University of the Arts understands and recognizes the duty to accommodate and to provide academic accommodations for students with disabilities, chronic health conditions, and temporary illness or injury. We are committed to decreasing and/or eliminating barriers to learning. Please note that academic accommodations do not exempt students from meeting course and program standards.

Process:

Step 1: Complete this Request Form with as all relevant information
Step 2: Submit supporting medical documentation at the bottom of this form or in the Documents tab after the form has been completed– either the AUArts Functional Assessment and Accommodation Form, Psychoeducational Assessment or other medical documentation
Step 3: Contact accessibility@auarts.ca and book an appointment to review your documentation and discuss your accommodation plan
Step 4: Meet with Accessibility Coordinator where next steps will be discussed

Protection of Privacy Statement

The personal information recorded on this form is being collected under the authority of Section 4(c) of the Protection of Privacy Act (POPA). The information will be used for the purpose(s) of providing disability-related accommodations and services and will be protected in accordance with section 10 of the POPA and used and disclosed in accordance with sections 12 and 13 of the Act. If you have any questions about the collection, use or disclosure of this personal information, please contact the Accessibility Coordinator at accessibility@auarts.ca or the University Secretary at access.privacy@auarts.ca.

First Name

Last Name

Middle Name

Chosen Name

Pronouns

Student ID

Please use your university issued email address

Phone Number

Please specify your diagnosis

Accommodation Information

Examples of classroom/studio and exam accommodations:

Notetaker
Permission to take short breaks during class and exams
Extended time to write tests and examinations
Distraction free space to write exams
Specialized technology
May require adjustments to class attendance expectation

What accommodation(s) have you received in the past, if any?

What accommodation(s) are you requesting?

Upload supporting document(s)

Medical documentation is required for all requests relating to illness, injury or disabilities and must include the following: disability/medical diagnosis, permanence and duration, the academic accommodations needed and any other needs/recommendations. Medical documentation is preferred in the form of the Functional Assessment and Accommodation Form but a letter or report from an appropriate medical professional is accepted. NOTE: Students whose current medical documentation is on file from previous related accommodations are not required to resubmit documents unless the new request is for additional or different accommodations.

Student Signature

In signing this form, it is understood that the information in this declaration will be kept under the Protection of Privacy Act (POPA) and understanding that knowingly providing false information or documentation is subject to sanction under the AUArts Student Conduct Policy and Procedures.