Athabasca University

Access to Students with Disabilities (ASD)
Extension Request Form

This form is for use only by students who are registered with Access to Students with Disabilities (www.athabascau.ca/asd) and require accommodations based upon permanent or temporary disabling condition.

If you are unable to access this form please contact 1-800-788-9041 extension 3424 or email asd@athabascau.ca

Important:

If you are in receipt of financial assistance to attend studies with Athabasca University, you are strongly advised to investigate options available through your funding sponsors/agencies if you request extended time to complete courses. Many sponsors/agencies have very strict guidelines regarding course completion dates and extending courses may seriously affect ongoing eligibility for student funding. If you are a Student Financial Aid (i.e. student loan funded) student you should also contact your Athabasca University Student Financial Aid Advisor by email at sfa@athabascau.ca to discuss any possible consequences requesting course extensions may have on your eligibility for student financial assistance. Students whom are in receipt of Student Financial Aid funding to attend full time studies must request their FIRST two month extension through their Athabasca University Student Financial Aid advisor



General Information

Fields marked with a * are required.

*Student ID:

*Surname:

*First Name:

Middle Name:

*E-Mail Address:

Home Phone (Include Area Code):

Other Phone (Include Area Code):

  • ASD students are permitted to request up to three two month extensions per individualized study course. Extensions are not available for grouped study courses and challenge courses
  • Extension requests must be submitted prior to the course contract end date.

Course(s) Information:

Enter First Course

*Course Code & Number (For example, ENGL 255): 

*Course start date (Please enter in the format YYYY/MM):

Contract end date (Please enter in the format YYYY/MM/DD):

 

 

Enter Second Course (If Applicable)

Course Code & Number (For example, ENGL 255):

Course start date (Please enter in the format YYYY/MM):

Contract end date (Please enter in the format YYYY/MM/DD):

Enter Third Course (If Applicable)

Course Code & Number (For example, ENGL 255):

Course start date (Please enter in the format YYYY/MM):

Contract end date (Please enter in the format YYYY/MM/DD):

Comments

If you have additional information that is relevant to this form, enter it here.
Please limit your comments to 100 words or less.

The personal information collected on this form will be used to process your extension request, and is collected under the authority of section 33 (c) of the Alberta Freedom of Information and Protection of Privacy Act. If you have any questions about the collection and use of this information, please contact the Professional Services Coordinator, Access to Students with Athabasca University, Edmonton Peace Hills Trust Tower 1200, 10011 - 109 Street Edmonton, AB Canada T5J 3S8, Telephone (780) 497-3424 Fax: (780) 421-2546


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Last modified by SAS - July 06, 2011, 13:46:10 MST/MDT