Government of Newfoundland and Labrador
Education and Early Childhood Development
Application for Student Access to AFM-NL
TO BE COMPLETED ANNUALLY
A. Student and School Information:
Name of Student:
Date of Birth: YY
Student Username :
School Year for which AFM requested:
School Name:
Mailing Address:
Stream:
English
NLESD Region:
Early French Immersion
Labrador
Western
DD
Late French Immersion
Central
Contact Teacher:
MM
Eastern
Contact Teacher e-mail:
B. Has this student received AFM previously?
Yes
No
If No, complete Sections B1, B2 and D. If Yes, proceed to Sections C and D
1. The student’s exceptionality(s) is:
Acquired brain injury
Hearing loss
Intellectual disability
Mental illness/mental health
Physical disability
Specific learning disorder
Speech &/or language disorder
Developmental delay/Supplementary intensive intervention
Medical condition - Specify type of medical condition
Neurodevelopmental and related disorders - Specify type of disorder
2. The student’s exceptionality(s) prevents or inhibits reading of the authorized learning resources
in the original format, due to an:
Inability to hold or manipulate a book
Significantly low reading comprehension development, as indicated through formal assessment
FOR EECD PERSONNEL ONLY
Acknowledged ____________
Approved ___________
Date_________________
Date___________________
or
Rejected __________
Date _________________
Reason for Rejection: ________________________________________________________________________________
Education and Early
Childhood Development
Application for Student Access to AFM-NL
February 2017
Page 1 of 2
C. Verification of Eligibility:
I certify that the student:
a. has an exceptionality, supported by a comprehensive assessment,
b. requires print resources in an alternate format, due to an inability to hold or manipulate a book and/or an
impairment in reading comprehension, and
c. has a current Record of Accommodations indicating that he/she requires alternate format materials.
D. Signature
Name
E-mail address
Ed. Psychologist
Guidance Counsellor
Hearing Itinerant/Teacher of the Deaf or Hard of Hearing
(permitted only for student with hearing loss)
__________________________________
Signature
Date
Important Information
1. The Contact Teacher for each student requiring AFM:
 Receives the student’s AFM password for online access
 Provides the password to the student
 Educates the student on how to access and use AFM resources
 Receives shipment of offline AFM ordered for the student
 Distributes offline resources to the student
 Returns offline resources to AFM-NL at the end of the school year
 Ensures the student and his/her parents/guardians are informed of copyright restrictions and
responsibilities.
2. The AFM Order Form is attached to the AFM Application when the AFM Advisor cannot access digital
resources through AFM-NL for the student or when offline resources are needed.
3. Applications received after May 15th may not be processed for September.
AFM-NL does not accept faxed applications. Applications may be emailed or mailed:
[email protected]
AFM-NL Intake
Student Support Services
Education and Early Childhood Development
Building 909, Pleasantville
P.O. Box 8700
St. John’s, NL A1B 4J6
4. Further information is available on the AFM-NL Learning Center at
www.gov.nl.ca/edu/k12/studentsupportservices/resource_center/index.html
Education and Early
Childhood Development
AFM Application
February 2017
Page 2 of 2