AMS Advocacy Intake Form

Preferred Name(Required)

First Last

Pronouns

Email(Required)

Phone(Required)

Format: (604) 123-4567

UBC Student Number(Required)

Faculty(Required)

Other

If you selected Other from the drop down, please indicate your faculty here

Student Type(Required)

Domestic Student

International Student

Case Type(Required)

Academic Misconduct

Academic Dispute

UBC Student Housing

Non-Academic Misconduct

Other

Please provide a brief description of your issue, any steps taken, and desired outcome(Required)

When is your next deadline? Please explain what the deadline is.(Required)

e.g. meeting with Dean’s Office on Friday, January 19

How did you hear about AMS Advocacy?(Required)

Online Search

UBC Referral

Social Media

Word of Mouth

Other

Would you benefit from any form of accommodation?

e.g. wheelchair access, interpreter, large print

Please upload any documents relevant to your case, such as emails, reports, lease agreements, etc.

PDF files are preferred. If you have multiple or larger files, you may need to upload as a ZIP file. If you exceed the limit, please upload your files to bit.ly/advocacy-upload.

Drop files here or

Accepted file types: doc, docx, eml, pdf, jpg, jpeg, png, zip, Max. file size: 128 MB, Max. files: 10.

Confidentiality Notice and Working Agreement(Required)

AMS Student Services, including AMS Advocacy, are confidential. Your personal information, including your name, your student ID or other identifying information collected by AMS Services will never be shared with external parties without your express permission, except if the following situations arise:

There are reasonable grounds to believe that you are likely to harm yourself or another person.

There are reasonable grounds to believe that a child or youth under 19 is at risk of being abused or neglected.

Your records have been subpoenaed by a court of law.

I understand and agree:

AMS Advocacy staff are not lawyers and do not provide legal advice.

AMS Advocacy will not handle my case on my behalf and it is my responsibility to make inquiries, draft documents, and follow up with relevant parties.

AMS Advocacy cannot act as my representative at a university hearing. I must personally appear and speak for myself.

AMS Advocacy may refuse assistance when services are being used for an improper purpose or there is no reasonable prospect of success.

AMS Services may share anonymized and aggregated information (e.g. faculty, issue type, common challenges) in public reports for both reporting and advocacy purposes. No identifying details (name, dates, detailed case information) are included. My explicit consent will be requested by AMS Services prior to sharing any details of my case which could be identifying in any way.

To indicate your understanding and agreement, please type your full name below.