Indigenous Services
Academic Transition Opportunities Program Application 2020-2021

Note: This application is to be completed after the Ontario Universities Application Centre application.

Section 1 - Personal Information

Note: If applicable, please submit supporting documentation (e.g. Status Care) to Indigenous Services.

Section 2 - Medical Information

This section is used to determine any health-related support you may required during the time you are a student at Western University.

Family Doctor Information:

Section 3 - Financial Information

Section 4 - Additional Information

Please take the time to answer a few short questions to help us to get to know you better and to better assess your needs.

Section 5 - Privacy Statement

Personal information provided in this application will not be disclosed to any person(s) outside of the Student Development Centre, Indigenous Services, or your Faculty at Western University, without your written consent. The information that you provide in this application is confidential, with the following exceptions:

  1. We are required by law to report to the appropriate authorities any suspicions that a child (i.e. a person who is under the age of 16) has been or is being abused.
  2. If you are in serious and imminent danger of hurting yourself or another person, we may need to reveal enough information to an appropriate third party to help you.
  3. If you are involved in a legal proceeding, the court may subpoena our records. This is a rare occurrence, but you should be aware of the possibility.

There may be other unique situations where there are exceptions to confidentiality. However, these confidentiality exceptions will be fully outlined and disclosed to you by your counsellor when relevant.

Information about your faculty, year of study, citizenship, area of concern, and any referral source will be kept in your file. This data will also be used as part of an aggregate database in order to provide information about the client population served by the Student Development Centre. There will be no identifying information in the aggregate reports that are generated.

Contact Information:

For questions or concerns please contact Mandy Bragg @ 519-661-4095 or email

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