Accommodation Request

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Student Information

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Must be University of Regina Student ID.
When you enter your email below...

You should ONLY type in your University of Regina student email.  PLEASE DO NOT TYPE A PERSONAL EMAIL BELOW.  The email address you type below should end with:

@uregina.ca

Please use your university issued email address ONLY. Your email address should end with @uregina.ca

Accommodation Specific Information

Upload supporting document(s)

Documentation may include, but is not limited to, the Diagnostic Verification Form or an Ed-Psych assessment report. The Verification Form and additional information about appropriate documentation can be found on the Centre for Student Accessibility homepage. The cost of obtaining documentation is covered by the student.

Statement of Confidentiality

Student Accessibility agrees to keep all information you share with us in the strictest of confidence. Under the Privacy Act and LAFOIPOP, we are unable to disclose any information without signed consent. However, we are required by law to disclose any information in the following situations: when we become aware of current child welfare issues; danger to self or others; or when otherwise legally required to do so. 

I have read the above Statement of Confidentiality and fully understand the terms and conditions.Required
Consent to Collect and Release Information

I give permission for Student Accessibility to contact the licensed health care professional or assessor listed on the disability documentation I have provided (i.e. physician, psychologist, psychiatrist etc.) for the purpose of sharing and collecting personal information regarding my educational and medical history related to my disability. I understand that in order receive formal accommodations, it is necessary for me to provide all relevant information concerning my disability. I consent to the release of information regarding my approved accommodations to my instructors, faculty, and other appropriate university personnel on a need-to-know basis.

I have read the above Consent to Collect and Release Information and fully understand the terms and conditions.Required
Accommodations Test Centre

Students writing accommodated exams the University of Regina’s Brad Hornung Accommodations Test Centre (ATC) must be aware of and agree to the following:

• Information related to exam accommodations will be shared with the ATC for the purposes of exam scheduling and ensuring that proper accommodations are met.

• All exams administered in the ATC will be monitored by closed circuit video surveillance. If you choose not to be under video surveillance during your exam in the ATC, you must either write the exam as scheduled with your class, or discuss alternate arrangements with your instructor.

• Students are expected to conduct themselves in a manner that does not distract or disrupt the educational pursuits of others. Harassment and abuse of staff and other students will not be tolerated.

I have read the above statement on the Accommodations Test Centre and fully understand the terms and conditions.Required
Nursing Students Only

I understand that in order to receive proper accommodations for my Nursing program, I need to register at both the University of Regina and Saskatchewan Polytechnic Accessibility Offices. I give permission for Student Accessibility to collect and share information with Saskatchewan Polytechnic in order to ensure consistent support in my Nursing program.

I understand the above statement and agree to allow Student Accessibility to collect and share information with Saskatchewan Polytechnic
Parent/Guardian Involvement (Optional)

I give permission to Student Accessibility to discuss my approved accommodations with my parents and/or guardians.

Student signature required.
DateRequired