Orientation to Accessibility Services

Name

First

Last

Email

Phone

Address

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Student ID

Program of Study

Are you already registered with Accessibility at your campus?

I have registered and sent my documentation already.

I will register and send my supporting documentation directly to my campus contact as per below.

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Campus

Haileybury Campus

Kirkland Lake Campus

Timmins Campus

Housing Information

I am renting an apartment or house

I am living at home and do not require residence

I am scheduled to move into residence

I have not secured a move in date to residence and need temporary accommodation during PS1001

Do you have allergies and/or food sensitivities?

No

Yes

Please describe your allergies or food sensitivities.

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone

I understand that this is an alcohol free environment

Yes

I understand there is a 100% attendance policy for PS1001

Yes

By submitting this form I agree to the terms outlined above

I agree

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Register for Orientation to Accessibility Services