# Accessibility Services - CollegeBound Registration Form (Timmins)

First Name:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

| | |
|---|---|
| Type | PDF |
| Size | 120 KB |

[Open original PDF →](https://www.northerncollege.ca/uploads/2025/07/CollegeBound-Timmins.pdf)

Referenced from: [CollegeBound: A Post-Secondary Transitional Program](/pages/students/collegebound/)

## Document text

<!-- image -->

## Accessibility Services - CollegeBound Registration Form (Timmins)

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 is attached.

Documentation to follow.

## Housing Information (Please check one.)

I have housing procured.

I will be living in Residence.

I have not secured housing and need temporary accommodation during CollegeBound.

Personal Information Do you have allergies and/or food sensitivities?

Yes

If yes, please list: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Relationship: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

## Emergency Contact Information

Emergency Contact:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Telephone:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Alt. Telephone:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

- [ ]  I understand that there is a 100% attendance policy for CollegeBound.

- [ ]  I understand that this is a substance-free environment.

- [ ]  I understand that CollegeBound requires a personal laptop . Tablets and Chromebooks are insufficient as per Northern College's BYOD policy.

- [ ]  I understand the deadline to apply for CollegeBound is Thursday, August 21st, 2025.

No

Please list any accommodations you require:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

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: TimminsAccessibility@northern.on.ca

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

---

<small>Source: [https://www.northerncollege.ca/uploads/2025/07/CollegeBound-Timmins.pdf](https://www.northerncollege.ca/uploads/2025/07/CollegeBound-Timmins.pdf)</small>