Verification of Accommodation (VOA) Form

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Student Information

To register with Accessibility Services, please complete this form, which includes Section 1: Self-Assessment and Section 2: Medical Verification upload.

Section 2: Medical Verification must be completed by a physician or regulated health care practitioner, your most recent psycho-educational assessment, or neuro-psychological report.

Medical Verification Requirements are found on our website.

Download the Medical Verification document for your health care practitioner to complete from our forms website.

Note: Other medical documents or disability verification forms completed for your provincial or territory funding agency can be submitted as Medical Verification. However, more detail may be requested if the uploaded documentation does not demonstrate the functional impacts or limitations in online learning requiring the recommended accommodations.

Medical Verification documents may be sent to Accessibility Services from your health care practitioner by emailing asd@athabascau.ca, or faxing 780 421 2546.

Visit the Accessibility Services website to learn more about our services and how we can support  your learning journey.

If you have questions or require assistance with this VOA form, please e-mail asd@athabascau.ca  or call 1-800-788-9041 to be transferred to Accessibility Services.

 

Protection of Privacy

The personal information that you provide on this form is being collected pursuant to section 4(c) of Alberta’s Protection of Privacy Act (POPA). Accessibility Services will use it to assess your eligibility for academic accommodations and support services, and for the administration and implementation of any accommodations or support services identified. Information will be disclosed to funding agencies and third-party service providers as necessary and appropriate. The information will be protected in compliance with the provisions of the POPA Act. If you have questions about the collection and use of this personal information, please contact the Office of the Chief Governance and General Counsel, Policy Privacy and Records Management.

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Please use your Athabasca email address

Section 1: Self-Assessment

Athabasca University is an online, self-paced learning environment and many of the courses have limited one-to-one interactions with professors. In general, there are no live lectures to attend and course content and material are found online.
Please indicate your intended/registered course load

This is the # of courses NOT a reduction in course content. For information on how many courses you are required to enroll in when using the reduced course load accommodation, please refer to our Course Management Accommodation page.

STUDENT DECLARATION

In registering with the Accessibility Services department as a student with a disability, I acknowledge that the above information presents an accurate reflection of my needs based upon my knowledge and experience of my disability.

I understand that I am responsible for maintaining communication with Accessibility Services regarding my needs and for participating on an ongoing basis in the accommodation process. I understand that additional supporting documentation may be required to support my request for services and/or an academic accommodation.

I understand that my request for services and/or academic accommodations will be reviewed by Accessibility Services to develop an individualized plan to support my learning activities. Consideration for accommodations includes functional abilities, symptoms, academic requirements, eligibility for funding, environment, geographic location, and other available resources. All the requested services and/or academic accommodations may not be available in each course that I enroll in.

I understand that Accessibility Services may be required to disclose information regarding my assessed academic accommodations to faculty and staff at Athabasca University to implement my accommodations.

I understand that Accessibility Services may be required to disclose information regarding functional limitations in academic to my funding agency when applying for the Canada Student Grant for Persons with Disabilities.

  
SECTION 2: MEDICAL VERIFICATION - Upload supporting document(s)

In order to start the accommodation process a VOA Section II – Medical Verification of Disability is required. Upload the verification of disability from a medical professional who knows your disability history and functional limitations or functional impact with regard to online learning. For more information review our Accommodation Process and Summary of Accepted Disability Documentation websites.