Confidential Intake and Self-Assessment Form

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Welcome to Accessible Learning Services

With a focus on academic accommodations and accessibility, we support students with Accessing their Abilities throughout their academic experience at Mohawk College. Whether you identify with experiencing mental health challenges, medical diagnoses, or identify with a disability, we meet students in a safe space, where they frame their own, unique lived experience.

Accessible Learning Services uses a strengths-based, empowerment model to support students with accessibility and accommodation needs enrolled in all Mohawk College programs and courses. Completion of this intake form is a first step in the collaborative accommodation planning process.

As part of the Ministry of Colleges and Universities, Mohawk College requires students to provide documentation, outlining functional limitations of concern; a diagnosis does not need to be disclosed. If you’re having trouble getting documentation, let us know and we’d be more than happy to help.

If you need help with the Confidential Intake Form or accessing your Accommodate Portal, contact Accessible Learning Services by email at als@mohawkcollege.ca or by phone at (905) 575-2122.

Assistive Technology can be used to access this form. A free screen reader can be downloaded from Natural Readers. If you have access to MohawkApps you can download and install Read&Write Gold.

Confidentiality and Consents

Statement of Confidentiality

Accessible Learning Services of Mohawk College agrees to keep all information you share in strictest confidence. Under the Freedom of Information and Protection of Privacy Act (FIPPA) we are unable to disclose any information without signed consent. We are required by law to disclose any information in the following situations: known and suspected instances of children who are or may be in need of protection; cases involving imminent risk of physical harm to oneself or another; known instances of inappropriate sexual contact by a regulated health care provider; or when subpoenaed for records or testimony by the courts.

When you register with Accessible Learning Services, a confidential digital file will be started. This file will contain information related to your intake, appointments, accommodations, services and contacts with our office, as well as your documentation of disability. This data will be entered into a computer program for data collection and statistical purposes. When reporting statistics, only group data is used without names of individuals or personal identifying information. Only Accessible Learning Services staff will have access to your file. Please visit our website for more information on Privacy and Confidentiality.

Internal Consent

I give permission to Accessible Learning Services staff to address questions/ concerns related to my Accommodation Letter and for obtaining/disclosing information for the purpose of intervening/advocating on my behalf. I agree that Accessible Learning Services staff can discuss the nature of the functional impact of my disability and answer questions related to my Accommodation Letter from Administrators, Faculty, and Staff. I agree that Accessible Learning Services can obtain or disclose information to other service areas of Mohawk College, as required, to support my success. I understand that Accessible Learning Services may be required to obtain or disclose information to student services at post-secondary institutions other than Mohawk (e.g., McMaster University, Ontario Learn) if I am enrolled in a program that is jointly administered between Mohawk College and another post-secondary institution

External Consent

Student information will not be disclosed to a third party unless specific instruction is given by the student and a release form has been signed. Please discuss external consent with your Accessibility Counsellor.

I have read the above Statement of Confidentiality and fully understand its terms and conditions. I understand that I can refuse to sign this consent form. This consent is valid from the date of the student’s signature and remains valid during the student’s term of study at Mohawk College unless consent is revoked.

  

Disability Documentation

Students are required to provide documentation outlining the functional limitations of their disability in order to receive academic accommodations. Disability documentation will need to be provided at least 3 days prior to an intake appointment with an Accessibility Counsellor. A disability diagnosis does not need to be specified. If you do not currently have documentation, continue with the registration process as temporary accommodations may be available to you while documentation is being acquired.

Upload Disability Documentation

Individualized Educaiton Plan (IEP), Psychoeducational Report (Psych-ed), Disability Verification Form (DVF), etc.

Please see our Guide to Disability Documentation on our webpage for more information.

To upload documentation:

  1. Click the 'Add Item' button below
  2. Provide a name for the document in the 'Document Type' field
  3. Click the 'Browse' button then navigate to where the document is and upload it. Name documents using the following format, 'STUDENT NUMBER, ALS DOCUMENTS' (for example 000000000, ALS DOCUMENTS.pdf)
  4. (optional) Provide a description for the document in the 'Description' field
  5. If you would like to add additional documents, please repeat steps 1 - 4

Personal Information

Have you previously studied at another Ontario College or University?Required
If yes, an email with instructions on setting up an appointment with our Student Transition Coordinator will be sent to you.

Enter your 9 digit student ID number. If you do not have one please contact als@mohawkcollege.ca for support. Please double check to ensure your student number is accurate before submitting.

If you are a student at the McMaster (IAHS) campus and/or you have a McMaster ID, please enter it here

Enter your Mohawk College email address (for example: firstname.lastname@mohawkcollege.ca). This is the primary email address the college will use.

Do you have a personal email address you would like to provide?Required

Enter your primary phone number

Enter your secondary phone number

What is the best way to contact you?
May we leave a message?
Optional: Are you enrolled in any of the following programs?

Disability Information

Providing a diagnosis is not required but if you decide to provide one, Accessible Learning Services will not disclose any information regarding your diagnosis or the disability documentation you share without your written consent. Please visit our website for more information on Privacy and Confidentiality.

If you would prefer not to disclose a diagnosis, please select one of the 'I choose not to disclose' options at the bottom of the list.

OPTIONAL: SELF ASSESSMENT

Reflect on skills such as reading, writing, focusing, organizing and managing your time, problem solving, engaging in group work, interacting socially, studying, and taking tests. Determine whether these skills represent areas of personal strength or areas where accommodations and support are needed.

If you do not have a disability diagnosis and suspect you may have a disability, describe the academic challenges you are currently experiencing and how it affects your learning and/or academic skills.

Next Steps

For intake appointments, You will receive an email within 3 business days in your Mohawk College email account from the ALS Front Desk with the name of your Accessibility Counsellor and instructions on how to book an appointment.

Would you prefer a virtual/phone intake appointment?Required
If you would prefer a virtual/phone intake appointment please select yes and you will be contacted with details, including a Zoom link for virtual appointments, through your Mohawk College email account. If you prefer an in-person intake appointment, please select no.