Center: View from Quad of Christ the King Chapel; Right: Students gathered together at Demske Sports Complex.
Inquiry Form
Accommodations & Services
Policies & Procedures

If you are a either a student currently attending Canisius College, or a prospective student, and would like information sent to you regarding the services, please complete the following online form.  Feel free to fill in as much or as little as you feel comfortable doing.
Student Information
First Name:
Last Name:
Student ID:
Gender: Male Female
Phone:
E-mail:
Address:
City:
State/Province:
ZIP/Postal Code:

Academic Information
  Prospective Student
  Freshman
  Sophomore
  Junior
  Senior
  Graduate Student
Major:

Disability
Have you (student) been diagnosed with a disability?   Yes  No
    If Yes, when :
 
Diagnosis/Disability:
   Physical
   Cognitive/Learning
   Psychological
 
Explain present limitation(s), if any, and how do you cope with the limitation(s) on a daily basis?

 

Do you (student) have current documentation (within 3 years)?  Yes  No
Did an office or person refer you (student) to DSS:  Yes  No
     If, Yes — who:

Information Requested
  Handbook
  Intake Form
  Psychologist/ Psychiatrist Referral Brochure
  Other, please explain:
 
Please Contact Me By:
  Mail
  Phone
  E-mail
 
Comments: