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Accessibility Services - CollegeBound Registration Form ( Haileybury)

First Name:_______________________________

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Referenced from: CollegeBound: A Post-Secondary Transitional Program

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Accessibility Services - CollegeBound Registration Form ( Haileybury)

First Name:_______________________________

Last Name:_______________________________

Preferred Name:__________________________

Cell Phone:_______________________________

Address: _________________________________

Email:____________________________________

City:_____________________

Province:__________________

Postal Code:__________________

Current School (if applicable):

______________________________________________________________

Program/Area of Study at Northern College (if applicable):_____________________________________

Please submit any accessibility support documentation (e.g PsychEd Assessment, IEP , or medical documentation) with this application, if you are submitting via email.

Documentation to follow.

Documentation is attached.

Please list any accommodations you require:

______________________________________________

I understand that the deadline to apply for Collegebound is Thursday, August 21 th, 2025.

Emergency Contact Information

Emergency Contact:_________________________

Relationship: _____________________________

Telephone:_________________________________

Alt. Telephone:____________________________

I have read the information on this form, and by signing, I agree to the terms outlined above.

_________________________________________________

Your confirmation can be submitted in person, or by email .

Email:

wigginst @northern.on.ca

Please contact us if you require this form in an alternative format.


Source: https://www.northerncollege.ca/uploads/2025/07/CollegeBound-Haileybury.pdf