Self Identification Form

 

     

In order to better meet the needs of students with disabilities at Nipissing University, this early identification and information form is made available for you to facilitate early communication with the Disability Services Office. 

This information is collected according to the following principles:

1. Participant identification is voluntary.
2. If you choose to identify yourself, all information is CONFIDENTIAL to Counselling and Disability Services and cannot be released without your permission.
3. Identification will not affect your admission status.

Please complete the attached form and forward it to:

Daralynn D'Angelo, Learning Strategist
Nipissing University
100 College Dr - Room A201H
North Bay, ON  P1B 8L7

or

Mike Walker, Learning Strategist
Nipissing University
100 College Dr. - Room A201G
North Bay, ON P1B 8L7

or

Office of Counselling and Disability Services
Fax: 705-495-2850

or

Copy the completed form into an e-mail and send it to daralynd@nipissingu.ca or mikew@nipissingu.ca as soon as possible.

The purpose of requesting this information is to assist the Disability Services Office to make early accommodations or arrange special services if requested by a student with a disability.

Attachments:

Self Identification Form (Microsoft Word File)

Self Identification Form (PDF File)