Meighen Centre Intake Form

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Student Information

Please enter your information

First Name

Last Name

Middle Name

Student ID

Please use your university issued email address

Phone Number

Street Address 1

Street Address 2

City

Province

Postal Code

Accessibility Specific Information

Instructions: There is much variability within each accessibility category, and therefore, the type of accommodations needed can vary significantly. Below, you will find descriptions of the various types of disabilities recognized in Canada. Student needs vary according to each individual. Therefore, it is important for the participating student to clarify the particular accommodations they request.

My diagnosed disability falls into the following category

Why are you looking to register with the Meighen Centre?

What, if any, academic accommodations/supports have you received previously?

What medical documentation are you providing to the Meighen Centre?

If you have supporting documentation, you may upload it here

Student Affairs values a team approach in assisting students. Therefore, staff working in different areas within this service (including Wellness Centre, Health Services, Meighen Centre and the Director of Accessibility and Student Wellness) may consult with one another to ensure that you are receiving the best possible care and to work effectively as a team.

Please be assured that information will not be shared with family members (without your consent, except when required by law) and will not become part of your school record.

I understand and agree to the information included on this form

Meighen Centre Intake Form

Student Information

Accessibility Specific Information

Document Information