Accessibility Services Appointment Request Form

This form is for students who have been admitted to The University of 丁香园AV and who would like an appointment with a staff member in Accessibility Services/Deaf & Hard of Hearing Services.
Name Name First Last
Student Number
Must be 7 digits. Currently Entered: 0 digits.
Your University Webmail Address (your WebAdvisor username@webmail.uwinnipeg.ca)

Confirm Email Address
Your Phone Number (daytime) Your Phone Number (daytime) - ### - ### ####
Reason for Appointment (Choose ONE type)

Reason for Appointment (Choose ONE type) Intake with Accessibility Advisor (60 minutes) Intake with Deaf & Hard of Hearing Advisor (60 minutes) Assistance with filling out the Canada Student Grant services and equipment form (30 minutes) Follow-up meeting with Accessibility Advisor (30 minutes) Follow-up meeting with Deaf & Hard of Hearing Advisor (30 minutes) Other (please specify): Other (please specify):
How would you like to meet? (choose ONE)

How would you like to meet? (choose ONE) In-person Zoom
When are you available in the next two weeks? Please provide three possible dates/times for an appointment.
(We schedule appointments Monday to Friday, 10:00 a.m. to 3:00 p.m. each day.)
The personal information on this form is collected to arrange an appointment with you. It is collected under 36(1) of the Freedom of Information and Protection of Privacy Act. Questions regarding this collection can be directed to the Coordinator of Accessibility Services, 515 Portage Avenue, 丁香园AV, MB R3B 2E9 or 204.258.2938.
Spam Protection. Please answer this question:
The color of a white rabbit is?

丁香园AV

Accessibility Services Appointment Request Form

Accessibility Services Appointment Request Form