Government of Ontario

Ontario Student Assistance Program (OSAP) Disability Verification Form: Students Attending Ontario Public Postsecondary Institutions

Purpose of this Form

This form is used to collect information about your disability, including documentation from your health care provider (doctor or other regulated health care professional). This information is used to verify your status as a person with a disability for Ontario Student Assistance Program (OSAP) purposes.

If verified, you may:

Help is available

The Office for Students with Disabilities or the financial aid office at your school can help you with any questions about this form. The Office for Students with Disabilities can also provide information about disability-related equipment, supports and services available at your school. For more information, see the “Questions?” section on page 2.

How to complete this form

There are two parts to this form: Section A and Section B.

Normally, you are only required to have this form completed once. Your health care provider may charge you a fee for completing the form. You are responsible for paying this fee yourself.

How to submit this form

Submit both Section A (completed by you) and Section B (completed by your health care provider).

  Upload it online:
  Log into your OSAP account at ontario.ca/osap and use the “Print or upload documents” feature

  Send the form:
  Send all sections of this form to the financial aid office at your school.

If you are sending in a paper copy, keep a copy of your form and related documents for your own records.

The privacy of all disability information is protected by the ministry under the Freedom of Information and Protection of Privacy Act.

Deadline to submit the form

The completed form must be received by your financial aid office no later than 40 days before the end of your study period.

Questions?

If you need help with this form, contact the financial aid office at your school.

The Office for Students with Disabilities can also help you with questions about how to complete this form. This office will also be able to provide information on other disability-related support and services available at your school. You may be required to provide them with additional documents when you discuss your disability-related needs for attending school.

Government of Ontario

2019-20 Ontario Student Assistance Program (OSAP) Disability Verification Form: Students Attending Ontario Public Postsecondary Institutions

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







Mailing Address








Government of Ontario

Ontario Student Assistance Program (OSAP) Disability Verification Form: Students Attending Ontario Public Postsecondary Institutions

Section A: Consents and declarations of student

Part 1: Required consents and declarations



Part 2: Optional consent and declaration of student

Sign and date this section only if you agree that your disability-related information on this form can be shared with your school’s Office for Students with Disabilities.

I authorize the financial aid office at my school and the Ministry of Colleges and Universities to disclose the personal information related to my disability (as provided on this form) to my school’s Office for Students with Disabilities if it’s required to determine my eligibility for the Ontario Bursary for Students with Disabilities and/or the Canada Student Grant for Services and Equipment for Students with Permanent Disabilities.



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 and in accordance with the consents you signed on your OSAP application. The Ministry of Colleges and Universities administers and finances OSAP under the legal authority set out on your OSAP application. If you have any questions about the collection, use and disclosure of your personal information, contact the Director, Student Financial Assistance Branch, Ministry of Colleges and Universities, PO Box 4500, 189 Red River Road, Thunder Bay, Ontario, P7B 6G9; 807-343-7260.

Section B: Verification of patient’s disability

To be completed by the student’s health care provider (doctor or other regulated health care professional).

The information provided on this form is used to determine your patient’s status as a person with a disability and their eligibility for disability-related funding and/or accommodations under the Ontario Student Assistance Program (OSAP). Eligibility is based on the student’s disability meeting the definition of permanent disability listed below. Students with temporary disabilities may be eligible for provincial disability-related funding.

Complete all pages in Section B. Provide clear statements about your patient’s disability-related functional limitations and/or restrictions. Avoid unclear terms such as “suggests” or “is indicative of”. If needed, provide additional details on your official letterhead and attach to this document.

Return the completed form and any attachments to your patient.

Patient information:



Part 1: Physician or regulated health care professional information



  

Specialty (indicate all that apply)













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

Declaration of physician or regulated health care professional

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



Section B: cont’d

  

Part 2: Patient's disability status

For OSAP purposes, the federal government defines a permanent disability as a functional limitation:

Does the patient have a disability (either permanent or temporary)?

If you answered “No” to the question “Does the patient have a disability (either permanent or temporary)”, no further information is required. Ensure the physician or regulated health care professional information section is completed, then return the form to the patient.

Choose ONE of the following statements that best describes the patient’s disability status.

Section B: cont’d

  

Part 3: Nature of patient’s disability

Check all that apply:






(e.g. autism, pervasive developmental disorder)


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




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



Note: OSAP eligibility criteria require that psycho-educational assessments must have been performed in the last 5 years or since the patient was 18. Individual Education Plans are not considered to be acceptable documentation of a learning disability for OSAP purposes.

Answer the following questions:

Has a psycho-educational assessment been performed by a registered psychologist?

If “Yes”, enter the date of the most recent assessment:

Was a learning disability confirmed?




Section B: cont’d

  

Part 4: Mobility and movement impacts

Check all that apply:








Part 5: Cognitive and/or behavioural impacts

Check all that apply: