NEADS Accessibility Resilience Program 2022 – 2023 – Application Form Step 1 of 3 33% The NEADS Emergency Relief Grant is intended to support expenses or needs that have not already been funded through other programs from federal or provincial sources.Contact Information:First Name(Required) Last Name(Required) Email(Required) Phone(Required)City(Required) Province/Territory(Required)AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonPermanent Disability AttestationDo you identify as a student with a permanent disability? Yes No Education Details:Post-Secondary Institution(Required) Student Number(Required) Program Year(Required) Name of Program(Required) Expected Graduation(Required) Month Day Year Type of Degree(Required) Select the field of study that best reflect what you are currently studying(Required) Economics/Business/Commerce Social Sciences Life Sciences Science/Technology/Engineering/Mathematics Humanities and Fine Arts Law Which unmet costs/needs would this grant fulfill? (check all that apply):(Required) Assistive technology Ergonomic desk equipment Cables Living Costs Educational training and software Other costs (e.g tuition, mental health/wellness costs)_. Which Grant Claim Amount are you requesting?(Required) $1000 maximum grant claim $5000 maximum grant claim QuestionnaireHow has the COVID-19 pandemic impacted your ability to fully participate in your education?(Required) Self-Declaration Form We recognize that students with disabilities are diverse and often have more than one marginalized identity, which impacts their ability to fully access education. The collection of data will help NEADS to bridge data gaps and further understand the perspectives and experiences of students with disabilities with multiple marginalized identities (e.g. Indigenous, Visible Minority, LGBTQ2+), in order to move towards programming that is more inclusive and bring support to students that need it most. As part of the 2022-2023 Accessibility Resilience Program, this information will also help NEADS prioritize students with disabilities from multi-marginalized populations for funding. Are you Indigenous? If so, how do you identify? First Nations Métis Inuit Not a part of the indigenous community Prefer not to answer Do you identify as a member of a visible minority?A member of a visible minority in Canada may be defined as someone (other than an Indigenous person) who is non-white in race, regardless of place of birth. Yes No Prefer not to answer Please select the relevant ethnicity group: Hispanic / Latino Caribbean Asian (South, East, West, North) African (South, East, West, North) Black Canadian Prefer not to say Please select your primary language: English French Mandarin Chinese Japanese Korean Punjabi Prefer not to say Do you identify as part of the LGBTQ2+ community? Yes No Prefer not to answer How do you identify? Straight Gay Lesbian Asexual Queer Pansexual Bisexual Questioning Transgender Non-binary Prefer not to say Other Other Are you a Canadian citizen by: Birth Naturalization (i.e. through immigration, first generation Canadian) Prefer not to answer Please identify your disability (or disabilities)? Attention Deficit/Hyperactivity Disorder (ADHD) Learning Disabilities Visually Impaired/Blind Deaf/Hard of Hearing Chronic Medical Disabilities Mobility Disabilities Head Trauma/ Acquired Brain Injuries Autism Spectrum Disorder Mental Health/Psychiatric Disabilities Other Other Before you submit, we want to know how you heard about us to help improve our awareness and outreach efforts.How did you hear about the Accessibility Resilience Program? NEADS social media post Financial aid office Another student On campus disabled students group Disability services department at my school Community organization Webpage other than neads.ca Other CommentsThis field is for validation purposes and should be left unchanged.