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Student Accessibility & Accommodation Request Form

Beal University Canada (BUC) strives to provide a diverse and inclusive learning environment to ensure that students with disabilities are provided with the opportunity to succeed academically. Accommodations are provided to support students with temporary and permanent disabilities.

We recognize that the term "disability" can be sensitive for some individuals, and that not everyone may feel comfortable disclosing or identifying with it. However, we use this term to ensure your rights are protected and to facilitate access to the necessary resources.

Students receive accommodations based on documentation received from a licensed health care professional and/or by meeting with our Student Services Accessibility Representative.

To access accommodations:

Students must complete this form and provide supporting documentation, if requested.

Students must meet with the Student Services Accessibility Representative to discuss the request.

Students will be notified in writing of a decision within 14 days of the original request.

Please complete all required fields below.

Student Information

Last Name	First Name	BUC Student ID Number

Address	City/Town	Province	Postal Code

Primary Telephone	E-Mail Address		Date of Birth (dd/mm/yyyy)

Program			Program Start Date (dd/mm/yyyy)

Type of Accommodation Requested

Please indicate the type of academic accommodation being requested.

Non-Health Related (Temporary)

Non-Health Related (Permanent)

Health Related (Temporary)

Health Related (Permanent)

If your request is a non-health related request, please specify the nature of your request:

Please complete the corresponding section based on the type of accommodation requested.

Non-Health Related Accommodation Request

Please describe the nature of the non-health related accommodation.

Please suggest any academic accommodations you are requesting.

How will the above requests help you maintain academic progress?

If this is temporary, please indicate the estimated timeframe that you are requesting this accommodation be in place:

Please provide any supporting documentation that may be useful in processing your request.

Health Related Accommodation Request

Please indicate the disability/disabilities that impact your learning (select all that apply):

Acquired Brain Injury

Attention Deficit Disorder (ADD) / Attention Deficit Hyperactivity Disorder (ADHD)

Autistic Spectrum Disorders (ASD)

Blind or Visual Impairment

Medical Condition (Chronic or Temporary)

Deaf, Deafened, or Hard of Hearing

Learning Disability

Mental Health

Physical Disability

Speech Impairment

Prefer not to disclose

Other (Please Specify):

Please provide a brief description of your disability and how it impacts your learning.

What are your current concerns with maintaining your academic progress related to your disability?

What strategies, resources, equipment, and/or assistive devices have you used in the past to achieve success related to your disability, either in previous education, employment, or daily life?

Please share your strengths that help you overcome obstacles.

Please suggest any academic accommodations you are requesting.

How will the above requests help you maintain academic progress?

Are you currently receiving student loans from any province? YesNo

Have you been granted disability status with your student loan? YesNo

If this is temporary, please indicate the estimated timeframe that you are requesting this accommodation be in place:

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.

Any documentation of a personal or medical nature can be submitted to the Student Services Accessibility Representative, who will not share this documentation with others without your consent. Only information related to any functional restrictions or circumstances that require accommodation may be shared to meet your accommodation needs and with your consent. The confidentiality of your personal and/or medical information will be safeguarded by the Student Services Accessibility Representative in accordance with privacy regulations.

Please provide supporting documentation that will assist us in processing your request.

Student Acknowledgement & Agreement Regarding Confidentiality

I understand that the personal information related to my academic accommodation request, including any supporting documentation, shall be treated as strictly confidential, and shall not be disclosed to other people without my consent. Information collected will remain separate from my student file. I understand that, in order to implement any academic accommodations, basic information may need to be shared with my instructor or others involved in the accommodation only to the extent necessary and only with my consent.

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January 31, 2025 3:46 pm EDT

Student Accessibility & Accommodation Request Form Uploaded by Sheree Rice - administrator@bealuniuversity.ca IP 71.255.159.238

March 19, 2025 10:57 am EDT

Student Services - ss@bealuniversity.ca added by Sheree Rice - administrator@bealuniuversity.ca as a CC'd Recipient Ip: 71.255.159.238

April 8, 2025 3:20 pm EDT

Student Services - ss@bealuniversity.ca added by Sheree Rice - administrator@bealuniuversity.ca as a CC'd Recipient Ip: 71.255.159.238