* indicates a required field
Please enter your information
Accessibility Services (AS) collects student personal/health information only as is reasonably required to confirm service eligibility and provide appropriate supports. When we collect, use, or disclose student personal/health information, we follow applicable Saskatchewan Polytechnic (SPT) policies and the laws with which they comply. For more information about our obligation to protect your privacy/confidentiality, please see SPT’s Privacy/Access page.
Purpose/Use of Student Intake Form
This form requires you to share a certain amount of personal/health information. We will use this information to create your AS registration record and to facilitate your first meeting with an accessibility counsellor. We will also use it to assist us in providing services/supports tailored to your needs.
Sask Polytech (SPT) Student ID Number
Please use your Sask Polytech (SPT) issued email address
AS requires adequate medical/disability-related documentation* to confirm student eligibility for services/supports.
For more information about documentation criteria, please visit this page.
Self-Assessment of Academic Needs
For example: coping strategies, assistive technology, personal counselling, other supports?
Confirmation of Form Completion
In signing this form, I acknowledge my consent to Accessibility Services’ collection, use and disclosure of my personal information, as outlined above.
Collaborative Nursing Students
I understand that in order to receive accommodations at both Saskatchewan Polytechnic and the University of Regina, I will need to register at both institutions. I give permission to Accessibility Services to collect and share information with University of Regina, Centre for Student Accessibility in order to ensure consistent support in the Collaborative Nursing program (SCBScN, ADNP and CNPP). I understand the above statement and agree to allow Accessibility Services at Saskatchewan Polytechnic to collect and share information with University of Regina Centre for Student Accessibility. Select I Agree below.
For Collaborative Nursing Students Only
University of Regina Intake
Upload supporting document(s)
Document verifying disability guidelines can be found here