Please provide the following information to assist the Learner Equity & Wellness Office in identifying if any additional supports are necessary for your success. Submission of this form is optional.
If you need to make any changes to the content you have submitted, please send an email directly to equity.wellness@schulich.uwo.ca.
The Schulich School of Medicine & Dentistry at Western University collects the personal information on this form under the authority of The University of Western Ontario Act, 1982, as amended, and uses it to identify if any additional supports are necessary for the success of its applicants and students. If you have any questions about Schulich’s collection, use or disclosure of personal information, please contact the Manager of the Learner Equity & Wellness Office, Schulich School of Medicine & Dentistry, Western University, Room K1, Kresge Building, London, Ontario, Canada N6A 3K7 or by telephone at 519.661.4234.
