Student Disability Accommodation Request Form

Student Information

This form is to be completed by any student who is new to the Student Services department and will be used to connect you the the appropriate services. Forms should be sent to

This information is collected so that we may address you in the most inclusive way. 

Government Student Loans

Academic Standing
Student Status (required)
Please choose one of the following statements

Disability Information
We acknowledge that the term "disability" makes some people uncomfortable and that some people may not be comfortable disclosing their disability or may not identify as having a disability. We use the term specifically with regards to protecting your rights and connecting you with the appropriate resources.

If you experience additional disabilities, please indicate them here

Current Functioning

Please give a brief description of your disability and how it impacts your learning at university. 
What are your current academic concerns, needs or questions related to your disability? 
If this is a temporary situation, what is the expected duration? 


Accommodations Prior to Beal University Canada (Required)


To protect the integrity of a rigorous academic environment, we require documentation verifying the existence of a disability from a registed health professional who is authorized to make a relevant diagnosis.

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 Services department, 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 department in accordance with privacy regulations.

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.