Application for Fred Smithers Centre for Student Accessibility

Before You Start

Please ensure you have the following ready before beginning the form information you'll need:

Your A Number (Saint Mary’s student ID that begins with "A" followed by 8 digits, e.g., A12345678). You can find your A number in your Admissions Letter or recover it online on the Saint Mary's Computer Accounts and Passwords page.

Basic personal information including your name, Saint Mary's email address, phone number, and student status.

Details on how your disability affects your academics (e.g., memory, concentration, reading, writing, physical access, etc.).

Documentation Required

You will need to upload a form completed by a qualified health care provider verifying your disability and its impacts. If you don’t have this yet, download the verification form, found at the bottom of this page, to give to your provider.

Need Help?

If you have questions or need assistance, please contact: fredsmithers.centre@smu.ca

Please complete all sections of the form

* Indicates a required field

Important Information

Your application will be processed based on the date received.

Please note that while we do use the term “disability” for documentation purposes, we acknowledge that self-identifying words vary from person to person. We welcome all students from the neurodiverse, Deaf and hard of hearing, and diverse ability community. We will always follow your lead on how you would like to be addressed.

When the application form and supporting documentation are received, you will be contacted by the Centre by email to schedule an Intake Meeting with an Accessibility Advisor. During this meeting, an advisor will walk you through the processes of obtaining accommodations within the classroom and for quizzes/tests/exams, as well as all other supports that are available to you.

A Number (Saint Mary’s Student ID – A followed by 8 digits) Example: A00123456. This is your Self-Service Banner username and is provided within your Admissions Letter.

First Name

Last Name

Preferred First Name (If different from your legal first name)

SMU Email Address

Preferred Pronouns (Let us know your pronouns – e.g., she/her, he/him, they/them)

Are you an international student? (Select yes or no)

Phone Number (Best number to reach you)

How does your disability affect you academically? (Examples: difficulties with focus, test-taking, note-taking, mobility, etc.)

I consent to receive email notifications from the Fred Smithers Centre Required (This allows us to contact you about your request and services.)

I agree to the sharing of relevant information with SMU departments as needed to support my academic success

I agree to the Fred Smithers Centre sharing my name, A number and other pertinent information with Admissions, the Service Centre, and other relevant departments (for example Academic Advising) at Saint Mary's University in order to best support my experience at SMU, as well as be considered for Scholarships & Awards.

Emergency Contact Information

Name

Relationship

Contact Information

FREEDOM OF INFORMATION AND PROTECTION OF PRIVACY

The Fred Smithers Centre for Student Accessibility together with Saint Mary’s University are committed to protecting the privacy of people who work and study here, as well as people who have previously worked and studied here. I understand that in submitting this application that my information provided on this form is collected by Saint Mary’s University and is used for the purposes of providing supports and services to students and for statistical purposes including internal annual reports and evaluation of our services. Any information collected will be protected and used in compliance with Nova Scotia’s Freedom of information and Protection of Privacy Act 1993, c5, s.1. For more information on privacy and confidentiality please visit (copy/paste) https://www.smu.ca/privacy/privacyatsmufoipop/. By applying for registration with the Fred Smithers Centre and by utilizing the services of the Centre, students consent to the collection of their personal information and its storage on Accommodate (a confidential electronic database for accommodation and student related information), and digital files (OneDrive and outlook e-mail) for educational, administrative and statistical purposes. The information is needed to process their application and to confirm their enrolment and registration in academic programs; to provide faculty with information regarding specific academic accommodations without disclosure of a diagnosis; to provide the basis for awards and governmental funding and for related record keeping purposes. Students agree that all information on the application form and supporting documentation submitted to the Fred Smithers Centre for Student Accessibility becomes the property of the University.

Please upload your medical documentation here by clicking the “Add Item” text button: If you do not have medical documentation, download the online Fred Smithers Centre’s Disability Verification Form, and have it completed by a medical professional before submitting this Application for Fred Smithers Centre for Student Accessibility form.

If you do not have documentation download this form and have it completed by a medical professional. Fred Smithers Centre’s Disability Verification Form

Click the “Submit” text button below to submit this form to the Fred Smithers Centre for Student Accessibility.

Application for Fred Smithers Centre for Student Accessibility