Student Accessibility Services Registration Form

Welcome to Student Accessibility Services! We are looking forward to working with you! The information you provide in this form will help us determine who, within our department, will best suit your needs, and will help us understand what supports you may require while you study at RRC Polytech. Please note that all information on this form is confidential.

Personal information collected during the intake process will be used by Student Accessibility Services for service delivery and planning purposes as per the Red River College Polytechnic Freedom of Information and Protection of Privacy policy and in compliance with The Freedom of Information and Protection of Privacy Act and the Personal Health Information Act. Absent an exception allowed by law, application and student information cannot be provided to anyone other than the student unless the student has provided written consent to Student Accessibility Services.

Note: Student Accessibility Services uses the term “disability” for consistency with the language of the Manitoba Human Rights Code.

Accessibility Services has received your registration form.

Someone from our office will be in touch with you within 3 business days to schedule an appointment. Thank you.

Return to Accessibility Services

Personal information

Emergency contact information

Program Information

Additional Information

Nature of Disability (check all that apply)

Appointment Details

If you have any difficulties completing this form, please email Student Accessibility Services.


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