Student Accommodation Request Form (Non‐Disability)

Use this form to request a non-disability human rights related accommodation as per the Student Access to Accommodations Policy. Submit this form to ss@bealuniversity.ca

Please note that documentation related to your request may be needed. Any documentation of a personal or medical nature can be submitted to the Student Servies department, who will share (as appropriate) only information related to any functional restrictions or circumstances that require accommodation. The confidentiality of your personal and/or medical information will be safeguarded by the Student Services department in accordance with privacy regulations.

CONFIDENTIAL

Student Information

Name: *

First

Last

Gender Pronouns (optional):

Position and Department/Program: *

Contact Information: *

Accommodation Details

1. Which non-disability human rights ground (s) is/are your academic accommodation request related to? Disability-related requests should be made through the Student Disability Accommodation Request Form. Religious/Cultural accommodation requests should be made through the Student Request for Religious and Cultural Observance Form. Students Seeking academic accommodation for childcare or eldercare may be expected to make reasonable efforts to first avail themselves of outside resources available to them prior to making an accommodation request. As such, we kindly ask that you indicate in the body of this request whether alternative arrangements have been explored to balance your caregiving and academic requirements (e.g. daycare, babysitting, shared responsibilities with partner, partner request for accommodation with their employer, family and/or friend support.) *

Family Status
Sex (including pregnancy, and brestfeeding)
Gender identity and/or gender expression
Other human rights ground(s) (please specify):

2. Describe the type of academic accommodation beings requested. *

3. Describe why the academic accommodation is required. *

4. What is the time period/duration you expect will be needed for this academic accommodation? *

5. Please provide any suggestions you have about what academic accommodations options we can explore, and any additional information that may be useful in processing your accommodation request. Please email (ss@bealuniversity.ca) any relevant information/further pages if applicable. *

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 persons 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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Date: *