Government of Ontario

2017-18 Disability Verification Form: Ontario Student Assistance Program (OSAP)

Purpose of this Form

This form is used to obtain information and documentation related to your disability from your physician or other regulated health care professional.

Do You Need this Form?

Before going further, first determine if you need to use this form.

If you are going to a publicly-assisted college or university in Ontario:
Contact your school’s Office for Students with Disabilities. They may have a different form that you will use instead of having this one completed.

If you have a learning disability:
You do not need to complete this form. Instead, you must provide a psycho-educational assessment conducted by a registered psychologist or psychological associate. To be considered, the assessment must have been completed either when you were at least 18 years of age or within the past 4 years.

If you are going to a private postsecondary school in Ontario or any postsecondary school outside of Ontario:
Use this form if you do not have documentation from your physician or other regulated health care professional that clearly provides the following information:

If You Use this Form

This information provided will be used to assess your eligibility for disability-related assistance under OSAP. The documentation is also required so you can be considered as a person with a disability based on the minimum student loan course load requirement.

Note:

Programs Included

Disability-related funding under OSAP includes:

Who's Eligible?

To be eligible for disability-related Canada Student Grants, you must have a permanent disability, which is defined as a functional limitation:

Students with temporary disabilities may be considered for the Ontario Bursary for Students with Disabilities. Talk to staff at your school’s Office for Students with Disabilities for more information.

How Often is This Information Required?

Normally, this form is required only once to confirm your disability. However, you may be asked to provide additional documentation at any time by the ministry or your school to confirm or re-establish your disability status. The privacy of all disability documentation is protected by the ministry under the Freedom of Information and Protection of Privacy Act.

How to Complete this Form

Fill out Section A and sign the Notice, Declarations and Consents. Then forward Section B to your physician or other regulated health care professional for their completion.

Where to Send Your Completed Form

Students attending an Ontario publicly-assisted college or university:
Contact your school’s Office for Students with Disabilities or Financial Aid Office to find out which of these two offices you should send your completed form.

Students attending an Ontario private postsecondary school or any postsecondary school outside of Ontario:
Send your completed form to the ministry at:

       Student Financial Assistance Branch
       Ministry of Advanced Education and Skills Development
       PO Box 4500, 189 Red River Road, 4th Floor
       Thunder Bay, Ontario P7B 6G9

Deadline

The completed form must be received no later than 40 days before the end of your current study period.

Government of Ontario

2017-18 Disability Verification Form: Ontario Student Assistance Program (OSAP)

Section A: Student Information (to be completed by the student)







Mailing Address








Consent and Declarations of Student





The personal information you and your physician or other regulated health care professional provide in connection with this form, including your Social Insurance Number (SIN), is collected and used by the ministry to determine your eligibility for disability-related assistance under OSAP.

Your personal information will be used to administer and finance the Ontario Student Assistance Program (OSAP) as set out in the notice of Collection and Use of Personal Information on your OSAP application form and in accordance with the consents you signed on your OSAP application form. The Ministry of Advanced Education and Skills Development administers and finances OSAP under the legal authority set out on your OSAP application form. If you have any questions about the collection, use and disclosure of your personal information, contact the Director, Student Financial Assistance Branch, Ministry of Advanced Education and Skills Development, PO Box 4500, 189 Red River Road, Thunder Bay, Ontario P7B 6G9; (807) 343-7260.

Section B: Disability Information

To be completed by a physician or other regulated health care professional.

Purpose and Instructions

This form will be used to determine your patient’s eligibility for assistance under the Ontario Student Assistance Program (OSAP) for students with disabilities. Eligibility for funding is based on the functional impact of the disability on the patient’s ability to participate in a postsecondary educational environment and, in some instances, the permanence of their disability.

Section B includes 3 pages. Ensure you complete all 3 pages. If you require additional space, please attach a letter (on your official letterhead) with the additional information. Provide clear statements, about your patient's disability-related functional limitations and/or restrictions, avoiding such terms as “suggests” or “is indicative of”. Once completed, please return all 3 pages to the patient.

Patient Information:




Physician or Health Care Professional Information:



  

Specialty (indicate all that apply)












I certify that the information provided on this form is accurate and the patient identified above experiences the disability-related educational barrier(s) indicated.




Note: If you do not have an office stamp, please sign and attach your letterhead to this form.

Section 2: cont’d

  

Type of Disability (check all that apply)


(e.g., paraplegia, quadriplegia, muscular dystrophy, cerebral palsy, spinal cord injury, spina bifida, multiple sclerosis)





Please indicate hearing loss in better ear:
           




(e.g., epilepsy, chronic pain, heart condition)






(e.g., autism, Asperger’s, pervasive developmental disorder, etc.)





Psycho-educational assessment performed?
     





If applicable, include copy of assessment (e.g., medical, psycho-educational, psychological, etc.)


Section 2: cont’d

  

Permanence of Disability

To be eligible for disability-related Canada Student Grants, your patient must have a permanent disability. Choose ONE of the following statements that best describes the patient.


    
    

Disability Impacts on Daily Functioning

Check all that apply









Cognitive and/or Behavioural Impacts

Check all that apply










Medication

Is the patient currently taking any prescription medications that may affect the patient’s participation in an educational environment?
  


Recommended Supports

Optional – Check all that apply