Returning Student Form

Contact Information

Name I Use

First Name

Last Name

Student Number

Nipissing Email Address

Note: Your Nipissing email is the primary mode of communication with SAS so check your email regularly.

Telephone Number

Alternate Telephone Number

Campus

Term

Funding Information

Have you applied for OSAP?

Are you eligible for OSAP?

Have you submitted a Disability Verification Form?

Academic Information

Current Year of Study

Are you on Academic Probation?

Has your program changed from last term?

Disability Information

Who is your Accessibility Consultant?

Has there been a change in your Disability Status?

If Yes, please inform your Accessibility Consultant by email or by appointment.

Accommodations

If you are eligible for the below accommodations, please ensure you complete the following steps in a timely manner:

If you require textbooks in alternate format, complete the Textbook Request Form
If you are eligible for peer note sharing or professional note taking, complete the Note Taking Request Form
Testing Accommodations must be booked by the appropriate dates listed here within the Clockwork Portal

Do you require any changes to your accommodations?

How would you like to meet with your accessibility consultant?

Additional Comments or Questions

Protection of Privacy

The information on this form is collected under the authority of the Nipissing University Act, 1992. It is related directly to and needed by the University to provide services and to support disability-related accommodation requests for students with disabilities. The information will be used by employees of the Nipissing University and will not be disclosed to any third party without your written consent. If you have any questions about the collection, use, and disclosure of this information, please contact Student Accessibility Services, Nipissing University 100 College Drive, North Bay ON P1B 8L7, (705) 474-3450, ext. 4362