Atlantic Centre of Research, Access and
Support for Students with Disabilities

Apply for Services Online

Please Read Carefully Before Proceeding
Please complete the following application if you wish to receive services through the Atlantic Centre. Your application will be processed based on the date received and our ability to provide the supports requested. Documentation of a disability must be provided. Some applicants may not be eligible for support services.

Last Name
 First Name
 Date of Birth
 E-mail

Local Address
Street

City

Province / State

Postal Code

Phone

Cell
 Mailing Address
Street

City

Province / State

Postal Code

Phone

Preferred Method of Contact:

Program:

Student Number (if known): A

Are you visiting from another institution?
If yes, which institution?
Anticipated start date:
High School Attended:
Year of Graduation:

Disability Information:

Please specify:

Please specify:

Please specify:

Please specify:

Do you have documentation of your disability?      
PLEASE NOTE: You will be asked for documentation of your disability. Be ready to provide documentation when asked.

Please check supports and accommodations that you have used in the past and found helpful:

You will be contacted for an interview by a representative of the Atlantic Centre.

    

 


This page last modified Friday, 30-Sep-2011 15:25:25 ADT