I am able to provide appropriate documentation to support my request if asked.        No    Yes

I understand that misrepresentation of an illness or circumstance (as listed in Table 1) constitutes academic dishonesty.           Yes

I have applied previously for exam accommodation at Mount Allison?            No    Yes                   More than once      

If I am granted an exam accommodation, I am eligible for services provided by either the Meighen Centre or Student Life office?         No    Yes

By submitting this form, I acknowledge having read and understood the information detailed on this form     No    Yes