Forms

This form should be used for 1 step TB Skin tests and is to be fully completed by the Health Care Provider ONLY.  Your Health Care Provider can use their own stationary but it must show:  Date administered;, Date read;, and Result;, along with Administered by: (name printed with signature), and name of clinic with full address (stamp with all info accepted).

Academic Integrity in Writing Declaration Policy

Health & Safety Accident Report Form - for an injury with or without medical aid. For an incident, without injury.

This form should be used by faculty and students who are involved in research projects which involve a legal Agreement with the funder.

Pension Plan for Professional Staff of Lakehead University members who wish to make additional contributions to the Plan can do so using this form.

If you are moving and need to update your address information, use this online form to have your address changed immediately. 

Address changes can be submitted through myInfo under the "Personal Profile" section and is an easy way to have your address information updated quickly.

Use this form to report incidents that occur when caring for/working with animals.

Appropriate Use of Electronic Devices Policy

OPSEU Banked Overtime Adjustment Form

Pay Schedule for United Steelworkers Union (USWA), International Union of Operating Engineers (IUOE), Ontario Public Service Employees Union (OPSUE), and UNIFOR Employees

Instructions for connecting to LakeheadU wireless on Blackberry devices.

This form can be used to plan your schedule for the fall term and winter term on paper before beginning to register on-line.

In cases where a significant breach of privacy has occurred, that is, disclosure of personal information contrary to the law, please complete this form (can be done entirely electronically) and send it confidentially, ideally as an email attachment, to the Director of Risk Management and Access to Information at mshaw1@lakeheadu.ca.

Please submit the report as soon as possible after the breach has occurred.

Department: Risk Management and Access to Information

LAKEHEAD UNIVERSITY SCHOOL OF NURSING 

 BScN UNIFORM POLICY

This form is to be used by Honours Bachelor of Commerce students in the Faculty of Business Administration who are declaring their major or changing to the Bachelor of Administration program. Please review the current program requirements found in the Lakehead University Academic Calendar prior to declaring your program. If you have any questions about your program requirements, discuss your decision with your program Chair.

Note: only forms approved by the Faculty of Business will be processed. Once a program has been updated, the student will be sent an email notification to their Lakehead University email account.

To be used for Cellular (Mobile) Telephone Reimbursement Request

Lakehead University is temporarily suspending the need for a student who is ill to provide a Certificate of Illness or Incapacitation completed by a Medical Professional as per University Regulation IV “Examinations – Missed Examinations Due to Illness or Other Extenuating Circumstances”.

For more information on procedures that have been temporarily implemented, please visit the Information For Students: Student Illness & Missed Exams page.

As per Lakehead University's Regulation, IV Examinations, occasionally, students encounter circumstances beyond their control where they may not be able to write a final examination for reasons such as serious illness or death of an immediate family member.

Note: The following applies only for exams scheduled during the official Examination Period (December and April). For missed exams, such as midterms scheduled by instructors, please consult the individual instructor.

In cases where a student misses a formal examination due to an incapacitating illness:

• the Certificate of Illness or Incapacitation (request to write a missed exam) must be completed by a Medical Professional (other medical notes will not be accepted)
• the Certificate must be submitted no later than three (3) working days after the date of the original final examination. Certificate of Illness or Incapacitation (request to write a missed exam) must be dated as seen by the Medical Professional no later than one (1) working day after the examination or three (3) working days if being seen by the Student Health & Wellness Centre (on campus).
• Payment of the $35.00 Deferred Exam Fee for each missed exam(which can be paid either at Student Accounts or Student Central)
• Proof of payment of the Deferred Exam Fee must be submitted with the Certificate of Illness or Incapacitation Form.

In cases where a student misses a formal examination due to other exceptional circumstances:

• official supporting documentation must be provided (e.g. copy of a death certificate or letter from the funeral home) and submitted no later than three (3) working days after the date of the original final examination.
• Payment of the $35.00 Deferred Exam Fee for each missed exam(which can be paid either at Student Accounts or Student Central)
• Proof of payment of the Deferred Exam Fee must be submitted with the Certificate of Illness or Incapacitation Form.

Official documentation (submitted by the dates above) must be dropped off at:

Student Central
Thunder Bay Campus: UC 1002 (next to the Agora)
Orillia Campus: Simcoe Hall

For questions or to check on the status of your deferred exam, contact: Nikki McCourt, Administrative Assistant at:

admin.vpsa@lakeheadu.ca
(807) 343-8522

Accommodation shall be granted only when the documentation indicates that the onset, duration and severity of the illness or other circumstances are such that the student could not have reasonably been expected to complete the examination on the scheduled date.

Upon receipt of the Certificate of Illness or Incapacitation (request to write a missed exam) or other supporting documentation and proof of payment, the Instructor will be notified to arrange for the student to write the missed examination. The final grade will be submitted to Enrolment Services as soon as possible after the rescheduled examination has been written.
Students will not be given another opportunity to write the examination if it is missed a second time. In some cases, when extraordinary circumstances beyond a student's control prevent him/her from completing the rescheduled examination, a student may be eligible to petition Enrolment Services to explain the circumstances.

Use this form to submit a cheque requisition, requesting payment for non-travel and non-hospitality charges, not made on a Lakehead Purchasing Card. Payments are reimbursed in either Canadian dollars or U.S. dollars.

Use this form to confirm your eligibility to work in Canada. This form should accompany your resume when applying for a position at Lakehead University.

Conflict of Interest and Non-Disclosure Agreement

Please visit the designated Visa Card Program webpage for more details on the corporate card program. There you can find the corporate card Visa application link.

Election to stop Contributing to the Canada Pension Plan, or Revocation of a Prior Election

To delegate signing authority to another researcher for expenditures up to $5,000

Use this form to request transfer expenses from one department to another.

Electronic Payment Form for vendors or persons to submit their direct deposit information. Please ensure to include a void cheque or a financial institution direct deposit transfer form when returning the Electronic Payment Form to Accounts Payable.

Ministry of Labour Employment Standards in Ontario

The Examination Cover Page is to be used by faculty, instructors and staff when submitting exams to the Scheduling Office within Enrolment Services - Academic Advising, Records and Registration.  This form is also available through myInfo.

This form is used to help faculty members when approaching equipment suppliers to meet the guidelines set by the federal government to govern CFI/ORF funding (for example, related to eligible in-kind contributions).

Federal TD1 Personal Tax Credits Return

Planning early and safe return to work - this form is filled out by health professionals to identify patient's functional abilities and work restrictions which will assist in their return to work.

Please complete the required information on the top of the sheet. When the student’s proposal has been approved by the Home Unit, the Supervisor will sign and date and then forward it along with a copy of the Proposal to the Gender and Women’s Studies Graduate Coordinator for review.

Graduate Assistant Assignment of Work (PDF Format)

Graduate Coordinators: Please complete one form for each Graduate Assistant in your program. Keep one copy for your files and send the original to the Office of Graduate Studies.

This form is to be used by graduate students who would like to change their route, option or specialization. Please fill in the form and discuss your decision with your Graduate Coordinator before submitting to Enrolment Services.

If you are looking to change your degree or your major, please contact the Faculty of Graduate Studies for assistance.

Note: graduate program change forms received after the last day to withdraw from courses in a given term will be effective at the start of the next graduate term.

Graduate Student Progress Report (PDF Format)

This form is to be completed at the initial registration of each graduate student and updated each May 1st. The form must also be retained by the Graduate Coordinator with a copy to be sent to the Office of Graduate Studies.

This form should be used when claiming reimbursement under your Health Care Spending Account, Health Care Expense Account or Health Services Spending Account for eligible expenses which are not covered (or not covered in full) by your Health or Dental Plan. 

As per Lakehead University’s Hospitality Expense Policy, all special events to be in any way funded by the University require prior approval from VP or President in advance. Please  complete the form with appropriate clarification to support selective, efficient, effective and  sustainable spending to benefit the University and/or its students.

How to access T4 and T4A on myInfo

As you prepare, conduct and follow-up on employee performance evaluation sessions as a supervisor, use this guideline to help you increase the likelihood of having a positive and productive exchange with your employees. Remember, the employee performance appraisal meeting is an opportunity to recognize achievements, identify and correct problems, and set specific goals and objectives for the coming year.

How to view your T4 on MyInfo

This document provides an overview of the collection, use and disclosure of Personal Information and Personal Health Information.  Each nursing student should review prior to signing the HSPnet Consent form.

Those applying to an undergraduate level Research Ethics Committee should use the Researcher Agreement Form.

For field trips with significant risks (i.e. most field trips), it may be advisable to require participants to read and understand, complete, and sign an informed consent or waiver.

If you are unable to obtain a "Criminal Records Check with Vulnerable Sector Screening" due to age restriction, you must complete this form and submit with clinical document package to Synergy.  If you become of age during your 1st year you must provide a "CRC with VSS" at that time.

To access the Publication Assistance Fund guidelines, click here.

Applications for this internal funding opportunity are only available through the Romeo Research Portal. To access the portal, please log into MyInfo and select "Romeo Research Portal" on the right.

This internal fund can be used to  develop a research project.  To access the RDF guidelines, click here.

Applications for this internal funding opportunity are only available through the Romeo Research Portal. To access the portal, please log into MyInfo and select "Romeo Research Portal" on the right.

This internal fund can be used to invite recognized scholars and/or research professionals to Lakehead University. Click here to access the guidelines.

Applications for this internal funding opportunity are only available through the Romeo Research Portal. To access the portal, log into MyInfo, then select Romeo Research Portal on the left.

Invention Disclosure forms are used by faculty members, researchers, inventors, and students when they are ready to disclose their invention/product/idea to the Office of Innovation, Partnerships and Economic Development.

All information submitted within this disclosure form shall be treated as confidential. Lakehead University reserves the right to release disclosed general information for the purpose of generating statistics, as long as such disclosure shall not adversely affect the scope of protection available to intellectual property.

Students can request a leave of absence using this form.

Students can use this form if they want to authorize another eligible person to sign for and negotiate the Ontario portion of their Canada-Ontario Integrated Student Funding Certificate.

Master's Thesis Forms

To be used when a Lakehead researcher is supplying or sending materials to someone outside of the University.   For agreement creation, please contact Ellen MacKay, Director, Innovation Development in the Office of Innovation, Partnerships and Economic Development, emackay@lakeheadu.ca.

Membership Nomination Form (PDF)

Complete this form if you are a Faculty member who wishes to apply for membership to the Faculty of Graduate Studies. Applications are to be submitted to your Graduate Coordinator.

Use this form as a placeholder for missing receipts, when submitted paper-based travel or hospitality claims and reconciled purchasing card statements. This form must be signed by the traveller/cardholder, as well as their direct supervisor, in addition to the claim form or the statement.

My Late Timecard Form

Use this form to submit hours worked that could not be entered to the online myTimecard system.

This letter is to be used when applying for Criminal Records Check with Vulnerable Sector Check.  It is a pdf fillable form and you must enter the date and your name once you have downloaded this form.

Payroll Direct Deposit Direction Bank Form 

This form is for changing your name or your beneficiary for pension purposes.

A Late Withdrawal is defined as dropping a course after the official drop deadlines.

Students may petition for late withdrawal on the grounds of illness or other compelling and documentable reasons for having been unable to withdraw from the course by its drop deadline. See University Regulation XI (b) 2. The petition for late withdrawal process can be completed using the link available through myInfo.

Professional Expenses Claim Form for Sessionals/Contract Lecturers (PDF)

The completion of this Form enables the St. Joseph's Care Group (SJCG) REB and LU REB to proceed through a Board of Record review process (if the project is applicable) such that the LU REB accepts the REB approval of the SJCG REB.

Provincial TD1 Ontario Personal Tax Credits Return

Please visit the designated Visa Card Program webpage for more details on the purchasing card program. There you can find the purchasing card Visa application link.

Our annual publication of the QN - Quaestiones Naturales showcases research achievements of undergraduate students in the Faculty of Science and Environmental Studies.

For each issue of our QN Magazine, see the following:

• QN Magazine Volume 7, 2019
• QN Magazine Volume 6, 2018
• QN Magazine Volume 5, 2017
• QN Magazine Volume 4, 2016
• QN Magazine Volume 3, 2015
• QN Magazine Volume 2, 2014
• QN Magazine Volume 1, 2013

Record of Employment (ROE) Information Sheet

Degrees or diplomas that have been lost, destroyed, damaged, or require a name change may be replaced at a cost of $50.00 plus delivery.  A Replacement Parchment request along with corresponding documentation must be submitted. The return of the original parchment is also required, or if not possible, a statutory declaration signed and sealed by a Notary Public.

If your original parchment has been lost or completely destroyed you will need to submit:

- a completed formal replacement parchment request form
- statutory declaration signed and sealed by a Notary Public
- replacement parchment fee
- delivery fee if mailing is requested

If your original parchment has been damaged you will need to submit:

- a completed formal replacement parchment request form
- the original parchment in its damaged condition
- replacement parchment fee
- delivery fee if mailing is requested

If your original parchment requires a name change you will need to submit:

- a completed formal replacement parchment request form
- the original parchment with the former name
- a completed Name Change form with corresponding government issued identification
- replacement parchment fee
- delivery fee if mailing is requested

NOTE:  Replacement parchments that have been requested and are being held for pick-up will be retained in Enrolment Services for one year from the reprint date. After that time, the replacement parchment will be destroyed and a new request with fee will be required.

Request for External Invoice Multi Vendor

This form has been developed to enable researchers to request access to their funding prior to obtaining Biosafety approval. Funds may only be accessed to cover expenses to be incurred before hazardous materials are used. This form is only available through the Romeo Research Portal.

Please contact the laboratory and biosafety specialist for more information labsafety@lakeheadu.ca

Checklist to assist students in completing and submitting their required clinical placement documents.

This form should be used when appointing a visiting professor, visiting research student, or short-term visiting researcher.

For Employees with Non-Occupational Injuries or Illnesses, Workplace Accommodations Can Be Arranged in Many Cases. Lakehead University will review the accommodations required to meet the restrictions, limitations or precautions which you place on this employee's return to work.

Our Speaker Series is an outreach event hosted by the Faculty of Science and Environmental Studies, held twice a year, in the fall and winter.

Dr. Hind Al-Abadleh

Date: Tuesday, November 15, 2022

Time: 7:00pm

ATAC 1001 / Zoom

To view the poster and register Click Here

  Past Speaker Series Events:

For each of our past Speaker Series Events, see the following:

2022

• Winter 2022

2021 

• Winter 2021

2020

• Winter 2020

2019

• Winter 2019

2018

• Fall 2018
• Winter 2018

2017

• Fall 2017
• Winter 2017

2016

• Fall 2016
• Winter 2016

2015

• Fall 2015
• Winter 2015

2014

• Fall 2014
• Winter 2014

2013

• Fall 2013
• Winter 2013

2012

• Fall 2012
• Winter 2012

2011

• Fall 2011
• Winter 2011

2010

• Fall 2010
• Winter 2010

Use this form to extend an expiring contract by 30 days or less.

Lakehead University Full Time Staff, Contract Staff, and Faculty Pay Schedule

Under the NSERC program terms for Engage awards, any Intellectual Property (IP) arising from the project (“Arising IP”) must belong to the company. To reflect these requirements, Lakehead University has developed an agreement which provides for the assignment of the Arising IP to the company. Consistent with NSERC policies and Lakehead’s policies and practices, this agreement also provides for a license to each of the creators of the Arising IP, and to Lakehead, to use the Arising IP for non-commercial research and academic purposes only.

Students Injured or Exposed in Clinical Setting Policy (with form)

System Access Form to request access of myBudgets (G/L security) and purchase order requisitions for new users, or updates for current users. Approver access can also be requested along with signing authority. Approver access includes access to myBudgets and to creating and approving purchase requisitions. Signing authority should be included with approver access, since a requisition requires approval by someone who has budget signing authority on the budget code used.

The Office of University Advancement is pleased to work with various departments and organizations as you plan events in support of Lakehead University. The following Third Party Event Proposal will assist you during the event planning process. This form must be completed and submitted to the Office of University Advancement prior to organizing your event.

Timecard and Leave Approval Proxy Designation instructions for supervisors of employees who enter hours worked to the online timecard system 

Timecard Entry Instructions for hourly employees to enter hours worked to the online timecard entry system

Travel Authorization Form to accompany Travel Expense Statement From.

Full-time employees must submit their travel expenses through Concur.

When is this form used?

Instructions for connecting to LakeheadU wireless via Ubuntu for Linux.

This year, each of the four Convocation ceremonies will feature a student speaker. If you are graduating this spring and attending your Convocation ceremony, we invite you to submit an application to be the "Voice from the Class of 2018" at your ceremony.

Visit our page for more information.

Instructions for connecting to LakeheadU wireless using Windows 10

Instructions for connecting to LakeheadU wireless using Windows 8

All new and students who are returning to the Nursing program following a leave (who have not previously completed) must complete this form and hand in with their Preclinical Document Package.