SSD Funding Request Policy Application Form This is the foundation for a funding application, though both itemized receipts or items quotes AND documentation from a registered medical professional must be included. Date Date Format: MM slash DD slash YYYY Name*UVic V-number*Email* PhoneAs of this semester, are you taking for-credit classes with the University of Victoria? (y/n)*Have you received funding through the SSD before?*YesNoIf you answered "Yes" to the previous question, when was that funding application full-filled?Funding Request Category*1. Transportation and Mobility2. Sensory Processing/Adaptation Tools3. Technology and Assistive DevicesFunding Request Category Number*1a. Wheelchairs/Scooters1b. Walkers1c. Canes/Crutches/Shoes1d. Transportation and/or Mobility Device not listed2a. Weighted Blankets or Plushies2b. Soft-lighted, incandescent lighting2c. Noise Cancelling Headphones2d. Sensory Processing/Adaptation Tool not listed3a. Adaptive technology3b. Adaptive software3c. Braille, Digital-Talking, or Large Lettered watch3d. Hearing Aids or FM devices3e. Eye Glasses3f. Technology or Assistive Device not listedName of item(s) being requested*If applicable, required specs on requested technology**Specialized specs may include larger screen size or increased computer memory or capacity to run specific software to course-work and disability accommodation simultaneously. Quoted amount for requested item(s) Drop files here or Accepted file types: txt, rtf, jpg, bmp, gif, webp, png, pdf, doc, docx. Please explain the relevance of the requested item(s) to your reducing your barriers, because of your disability(ies), to participate in your studies with the University of Victoria:*Please upload relevant documentation from a registered medical professional: Drop files here or Accepted file types: txt, rtf, jpg, bmp, gif, webp, png, pdf, doc, docx. Ensure that the registered medical professional notes that the *specific* item(s) you have requested are needed for you because of and pertaining to your disability(ies).CAPTCHA