Student Federation Accessibility Fund

Subsidy Request Form (2010-2011)

For more information on the Accessibility Fund, the application procedure, or eligibility criteria, please refer to the Accessibility Fund Introduction available at the Student Federation office or the Centre for Students with Disabilities.

Section A: Applicant Information

Applicant Name: Student No.: Organization: Position: _________________________________________ _________________________________________ _________________________________________ _________________________________________

(Student if you are not applying on behalf of an organization)

E-mail: _________________________________________ Phone number: _________________________________________ Preferred method of communication: __________________________________ Date of request submission: _________________________________________

If funding is granted for this request, the cheque shall be made to: _______________________________________________________________

Section B: Event Information

This section should be completed only if it is applicable. For example, if you are applying for funding as an individual student to supplement ADP and BSWD funds, this form does not apply. Event Date/Time(s): ________________________________________________ Event Title: ________________________________________________ Location: ________________________________________________ Description of Event:

___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ _______________________________________________________________

Estimated number of students attending the event:

_________________

Were there any specific accessibility requests made for your event? If so, please attach related documents (forms, emails, etc). _____________________________________________________________________ If you are receiving any other funds to make the event accessible, how much? _________________________________________________________________ Source of the funding:__________________________________________________

Section C: Accommodation Requests

In terms of disability accommodations, for which purposes are you seeking financial supports through the Accessibility Fund? Check all that apply. [ ] Individual students- personal purchases (equipment, support services) [ [ [ [ etc) [ ] Adaptive computer software (screen reader, OCR package) [ ] Physical environment modifications (renovations, space fluidity) [ ] Sign language interpretation (ASL, LSQ) [ ] Training and awareness promotions (Disability training) [ ] Other (please specify): ] ] ] ] Accessible facility rental Accessible transportation arrangements Alternative format of materials (Braille, large print, etc) Adaptive equipment (adjustable height tables, wheelchair,

___________________________________________________________________ ___________________________________________________________________ _______________________________

Detailed breakdown of what is required, costs, source of supplies, etc.:

____
Please attach additional pages if required

This page is for your information and does not need to be included when you submit your request.

Supporting Documentation Required

For all applicants: All requests must be supplemented with a list of the service provider, manufacturer, or other agency that will be providing the good or service. Quoted costs should be included in the application, including the source of the quotes. Please attach the quote. For requests exceeding $1000, the applicant will be required to attend the relevant Accessibility Committee meeting to discuss their application. If you are applying to the fund to seek the purchase of adaptive equipment or other services, please submit relevant financial documentation demonstrating financial need. The Accessibility Fund Committee meets once a month to review subsidy request. You will be contacted with the outcome of your subsidy request following each meeting. To know the dates of the meetings, please contact CSD or the VP Finance and see contacts below.

Submitting Your Application

When you have completed this application, please place the form and all documentation in an envelope, address it to the Accessibility Fund Committee and: Drop it off in person at the Student Federation office (07 UCU) to the attention of the VP Finance Mail it to: Accessibility Fund Committee c/o SFUO (VP Finance) 85 University Pvt, rm 211-F Ottawa, ON, K1N 6N5 E-mail your application to vp.finance@sfuo.ca in plain text or Microsoft word

Questions, comments or concerns?

Centre for Students with Disabilities 211-F UCU in the Terminus 613-562-5800 x2683 csd@sfuo.ca VP Finance 07 UCU, SFUO office 613-562-5800 x4070 vp.finance@sfuo.ca