ACCESSIBILITY SERVICES REQUEST FORM

First Name

Last Name

Student Number

CNA Student Email (enter your email in this format: Firstname.Lastname##@ed.cna.nl.ca

Alternate Email

Phone Number (enter your phone number in this format: 999-999-9999)

Street

Community

Province

Postal Code (enter your Postal Code in this format: A1A1A1)

Country

Program

At which campus are you registered?

Indicate registered Course(s):

Have you previously received accommodations at CNA?

Yes

If Yes, Indicate Campus

Comments

I have read and understand the Privacy Statement below and consent to the collection and use of this personal information.

College of the North Atlantic is an educational body of the Government of Newfoundland and Labrador, and is therefore subject to the Access to Information and Protection of Privacy Act, 2015 (ATIPPA). Student Services is collecting your personal information to process your request and to update your academic record. It will only be used for this purpose. All personal information you provide may be disclosed to Admissions staff. This personal information is collected under the authority of the College Act 1996 (SNL1995, Chapter C-22.1). Collected personal information will be stored in accordance with our normal network and information security measures.

For further information about the collection and use of this information please email learn@cna.nl.ca. For more information about the ATIPPA please visit www.cna.nl.ca/about/atippa.asp.