Public Accommodation Request

* indicates a required field

Student Information

Welcome to Accessibility Services at Mount Royal University!

Please complete and submit the information below. We will contact you to arrange a conversation with an Access Advisor.

Documentation Requirements

Please be advised that documentation of disability is required in order to access our services. The documentation of disability must be:

(i) From a physician, psychologist, audiologist, ophthalmologist or other licensed specialist;

(ii) Submitted on letterhead and include the clinician’s name, title, phone number, address, dates(s) of assessment(s); and

(iii) Dated.

In addition, the documentation must indicate the impact the disability(ies)/condition(s) has on the student in an academic setting. It may identify or recommend specific accommodations and supports that would reduce the barriers encountered in an educational setting.

Please note: Unless you have another documented disability, we do not provide accommodations for:

• exam anxiety

• English as an additional language

First Name *

Last Name *

Middle Name

Are you a current MRU student or have you applied to attend MRU? *

Please answer "Yes" if you have an MRU student ID number.

Date of Birth *

Email *

Please use your university issued email address if you have one.

Primary Phone Number *

May we leave messages at the Primary Phone Number? *

May we leave messages at the Secondary Phone Number? *

Confidentiality *

1. Accessibility Services as the department responsible for requesting, receiving, and retaining medical or psychological information provided by students requesting an academic accommodation. Your information is confidential and cannot be shared with anyone outside of Accessibility Services without your written consent. There are 3 exceptions to this:
1. if you or another person is at risk of serious harm,
2. if you admit to child abuse or child neglect, or
3. if your information is subpoenaed in a court of law.
Your information is only shared, on a need to know basis, with Accessibility Services staff.

Indicate below if you have read and understood the confidentiality content.

Consent to Share Information

I give permission to Mount Royal University, Accessibility Services, to share information with the following individuals: (Specify by name - not "Mom")

Public Accommodation Request

Student Information

Welcome to Accesssibility Services