New Student Intake Form

UofG Email Address (if known, otherwise use your personal address)

Student Number
This is a 7-digit number and starts with 0 or 1

Primary Contact Number
Format: 555-555-5555

Alternate Contact Number
Format: 555-555-5555

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
Has a health care professional provided you with a diagnosis related to your disability?

Yes

Please check one or more of the following to describe your disability. If you checked more than one disability, please indicate the ONE which has the greatest impact on your learning in the box below:

Hospital or emergency care
Have you recently been in the hospital or received emergency care related to your disability?

Yes

Academic Standing

Student Status
Please choose one of the following statements

Future student: not yet admitted to UofG

New Student: first year on campus

Continuing student but new to SAS

Absence from school
Have you recently experienced an absence of 2 weeks or more from school for disability-related reasons?

Yes

Academic Deadline
Do you have a pressing academic concern that requires attention in the near future?

Yes

Previous semesters
Have you failed courses or are you on academic probation as a result of your disability?

Yes

Outstanding courses
Do you have any deferred exams or incomplete coursework from a previous semester?

Yes

Resources

Accommodations Prior to UofG
Did you receive accommodations in high school or at another post-secondary institution?

Yes

Counselling at UofG
Have you used Counselling Services at the U of G in relation to your disability?

Yes

Current Functioning

Impact on Learning or Daily Living
Please give a brief description of your disability and how it impacts your learning or daily living at university.

Current Academic Concerns
What are your academic concerns related to your disability?

Temporary Situation
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.

Personal Information

Disability Information

Academic Standing

Resources

Current Functioning

Documentation