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Canadian Armed Forces Military Personnel Instruction 02/19 – Annexes – Learning Disability Accommodation During Recruiting, Training and Education

Annexes

  1. Annex A – Consent from CAF applicant to undergo a psycho-educational assessment 
  2. Annex B – Consent from CAF member to undergo a psycho-educational assessment
  3. Annex C – Letter of referral for CAF applicant to undergo a psycho-educational assessment
  4. Annex D – Letter of referral for CAF member to undergo a psycho-educational assessment
  5. Annex E – Learning Disability Accommodation Request Process

 

   

Chef of Military Personnel Crest

Annex A – Consent from CAF applicant to undergo a psycho-educational assessment 

Consent from CAF applicant to undergo a psycho-educational assessment

I, [Alpha Number or Service Number, Title, First Name and Surname] consent / do not consent to Dr. Brian Smith [Title, First Name and Surname of the licensed psychologist] conducting a psycho-educational assessment on me. Also, I consent to disclose this assessment to the applicable Department of National Defence (DND) and Canadian Armed Forces (CAF) personnel for the conduct of an accommodation assessment in accordance with DAOD 5516-5, Learning Disability Accommodation, During Recruiting, Training and Education. 

Also, I understand that CAF applicants will have to pay out-of-pocket for their psychoeducational assessments.

[CAF applicant’s Signature] [Date (dd-mm-yyyy)]

[Recruiting Staff’s Signature] [Date (dd-mm-yyyy)]

Annex B – Consent from CAF member to undergo a psycho-educational assessment

Consent from CAF member to undergo a psycho-educational assessment

I, [Service Number, Rank, First Name and Surname] consent / do not consent to [Title, First Name and Surname of the licensed psychologist] conducting a psycho-educational assessment on me. Also, I consent to disclose this assessment to the applicable Department of National Defence (DND) and Canadian Armed Forces (CAF) personnel for the conduct of an accommodation assessment in accordance with DAOD 5516-5, Learning Disability Accommodation, During Recruiting, Training and Education.

Also, I understand that CAF members will have to pay out-of-pocket for their psychoeducational assessments and that CAF members will be authorized to request reimbursement from their Commanding Officer (CO).

Finally, I understand that should a CAF member decide not to pursue the Learning Disability (LD) accommodation request after a psycho-educational assessment has been completed and the CAF member has been reimbursed, the CAF will be authorized to recover the costs from the CAF member.

[CAF member’s Signature] [Date (dd-mm-yyyy)]

[CO’s Signature] [Date (dd-mm-yyyy)]

Annex C – Letter of referral for CAF applicant to undergo a psycho-educational assessment

17 Wing
PO Box 17000 Stn Forces
Winnipeg MB R3J 3Y5

April 2019

To whom it may concern The Canadian Armed Forces (CAF) is referring [Title, First Name and Surname], a CAF applicant for a psycho-educational assessment. In accordance with the Defence Administrative Order and Directive (DAOD) 5516-5, Learning Disability Accommodation During Recruiting, Training and Education and part 1 of the enclosed Form DND 4458-E, this individual has consented to undergo a psycho-educational assessment in order to determine if he/she has a learning disability that could be accommodated in the CAF.

As part of the psycho-educational assessment report, the CAF requires the following:

A description of the learning disability.

A clear description of the nature and extent of the functional limitations specific to the individual that result from the learning disability, including any professionally recognized standardized test results and any use of systematic or differential assessments.

Any recommended accommodation(s).

A list of any accommodations that this individual is currently using or has used, as well as any means by which the individual compensates for the functional limitations.

When applicable, a description of the variability or of the progression of the individual's functional limitations.

The individual’s history, whether educational, developmental or medical, if relevant to understanding the learning disability for the purpose of providing accommodation.

Please note that the CAF applicants are responsible to pay for all costs associated with psycho-educational assessments. Any queries related to this referral may be directed to our recruiting staff, [Rank, First Name and Surname] at [Phone Number].

Yours truly.

 

[First Name and Surname]
[Rank]

Enclosures: 2

Annex D – Letter of referral for CAF member to undergo a psycho-educational assessment

Letter of referral for CAF member to undergo a psycho-educational assessment

17 Wing
PO Box 17000 Stn Forces
Winnipeg MB R3J 3Y5

April 2019

To whom it may concern The Canadian Armed Forces (CAF) is referring [Rank, First Name and Surname], a CAF member for a psycho-educational assessment. In accordance with the Defence Administrative Order and Directive (DAOD) 5516-5, Learning Disability Accommodation During Recruiting, Training and Education and part 1 of the enclosed Form DND 4458-E, this individual has consented to undergo a psycho-educational assessment in order to determine if he/she has a learning disability that could be accommodated in the CAF.

As part of the psycho-educational assessment report, the CAF requires the following:

A description of the learning disability.

A clear description of the nature and extent of the functional limitations specific to the individual that result from the learning disability, including any professionally recognized standardized test results and any use of systematic or differential assessments.

Any recommended accommodation(s).

A list of any accommodations that this individual is currently using or has used, as well as any means by which the individual compensates for the functional limitations.

When applicable, a description of the variability or of the progression of the individual's functional limitations.

The individual’s history, whether educational, developmental or medical, if relevant to understanding the learning disability for the purpose of providing accommodation.

Please note that the CAF members are responsible to pay for all costs associated with psychoeducational assessments. Any queries related to this referral may be directed to our medical staff, [Rank, First Name and Surname] at [Phone Number].

Yours truly.

 

[First Name and Surname]
[Rank]

Enclosures: 2

Annex E – Learning Disability Accommodation Request Process

Descriptive Text - Working Remotely - Proposed Place of Duty Outside of Place of Duty of Gaining Unit/Detachment
Step Responsible Action
1 – LD Accommodation Request Submission Individual
  • Disclose a LD
  • Request a LD accommodation by completing Form DND 4458-E Part 1
  • Submit to Recruiting Staff or CO the Form DND 4458-E, a valid Psycho-Educational Assessment Report (if one exists) and any other original documents relevant to this request
Recruiting Staff of CO
  • Review Form DND 4458-E Part 1 and any additional documents
  • Complete Form DND 4458-E Part 2
  • Determine if a Psycho-Educational Assessment is required
N/A

Psycho-Educational Assessment required?

  • No: Proceed to Step 4.
  • Yes: Proceed to the next step.
2 – Psycho-Educational Assessment Referral Recruiting Staff or CO
  1. Inform the individual that he/she will need to pay out-of-pocket the Psycho-Educational Assessment and ONLY CAF members can request reimbursement
  2. Seek the individual's consent to undergo a Psycho-Educational Assessment using Annex A or B of CAFMPI 02/19
N/A

Individual Consent?

  • No: Cease the process
  • Yes: Proceed to Step 2 Continued
2 – Psycho-Educational Assessment Referral (Continued) Recruiting Staff or CO
  • Review the “Public Service Guide for Assessing Persons with Disabilities”
  • Assist the individual in identifying a local Licensed Psychologist
  • Inform the individual to make an appointment with the identified Licensed Psychologist
  • Provide to the individual an envelope including Annexes A or B and C or D of CAFMPI 02/19 for transmission to the Psychologist
  • Inform the individual to brief the Recruiting Staff or Chain of Command of all appointment dates
Individual
  • Complete Annex A or B of CAFMPI 02/19
  • Make an appointment with the identified Licensed Psychologist
3 – Psycho-Educational Assessment Individual
  • Transmit to the Psychologist, the envelope received from the Recruiting Staff or CO; including Annexes A and C or B and D of CAFMPI 02/19
  • Inform the Psychologist to review the CAF documents before conducting the Psycho-Educational Assessment
  • Submit payment to the Psychologist
  • Return in an envelope to the Recruiting Staff or CO the original Psycho-Educational Assessment report and any relevant documents used by the psychologist to prepare this report
Psychologist
  • Consult CAF documents prior to conducting the Psycho-Educational assessment
  • Submit any queries to the Recruiting Staff or CO
  • Conduct the individual’s Psycho-Educational Assessment
  • Prepare a Psycho-Educational Assessment report
  • Brief the individual on the results of the Psycho-Educational Assessment report
  • Collect payment from the individual
  • Submit receipt(s) to the individual indicating that the invoice(s) has/have been paid
  • Submit to the individual, in an envelope, a copy of the individual’s original Psycho-Educational, Assessment report; including any relevant documents used to prepare the report
DPGR 4-4
  • Track all financial transactions processed in DRIMS Internal Order 11753733 associated with CAF members Psycho-Educational Assessments and produce quarterly reports as required.
Recruiting Staff of CO
  • Send to DPGR 4-4 by encrypted email a scanned copy of all documents received from the psychologist including Form DND 4458-E
  • Insert a copy of the CAF applicant’s Psycho-Educational Assessment report in the Enrollment Medical Forms (CF 2027)
  • Send a copy of the CAF member’s Psycho-Educational Assessment report to the CF Health Services Centre for insertion in the CAF member’s medical file
  • Return to the individual the original Psycho-Educational Assessment report including any relevant documents used to prepare the report (ONLY DPGR 4-4 and the Medical Staff are authorized to keep copies of Psycho-Educational Assessment reports. Units are NOT AUTHORIZED to keep copies of these reports.)
  • Give to the CAF member a copy of Form DND 4458-E Annex A completed authorizing the CAF member’s reimbursement for a Psycho-Educational Assessment
  • Inform the Unit Claim Section in the event that the CAF member decides not to pursue a Psycho-Education assessment after the assessment has commenced
Medical Staff
  • Consign in the CAF member’s medical file a copy of the CAF member’s Psycho-Educational Assessment report and any documents used to prepare the report
Unit Claim Section
  • Reimburse the CAF member for the Psycho-Educational Assessment using a CF 52 General Allowance Claim with General Ledger (GL) 4315 - V1 Educational Consultants, and Internal Order (IO) 11753733 following the receipt of Annex A of Form DND 4458-E from the CAF member which was previously filled out by the CO.
  • Recover from the CAF member the cost of the Psycho-Educational Assessment, in the event that the CAF member decides not to pursue a Psycho-Educational assessment after the assessment has commenced.
  • Send by encrypted email a copy of all CF 52 to DPGR 4-4 for financial expenditures tracking purposes.
  • Inform by encrypted email DPGR 4-4 of any recovering process.
CAF Member
  • Submit for reimbursement to the Unit Claim Section the receipt(s) from the Psychologist indicating that the invoice(s) has/have been paid and a copy of Form DND 4458-E Annex A received from the CO authorizing the reimbursement.
  • Reimburse the Receiver General of Canada any funds already received to date in the event that he/she decides not to pursue a Psycho-Education Assessment after the assessment has commenced and he/she has been reimbursed
4 – LD Accommodation Request Assessment DPGR 4-4
  • Review Part 1 and 2 of Form DND 4458-E and all documents submitted by Recruiting Staff or CO
  • Sever any medical information included in the Psycho-Educational Assessment report and do not consider this information in the assessment process
  • Assess in consultation with appropriate subject matter experts, the LD Accommodation request considering the different developmental periods of a CAF member’s career
  • Determine if an individual with a LD is capable or not of meeting the minimum operational standards related to Universality of Service (U of S)

Meet U of S?

No:

  • Recommend no accommodation

Yes:

  • Complete Form DND 4458-E Part 3 on behalf of DPGR detailing the approved and non-approved accommodations, with reasons
  • Substantiate any denial of a LD Accommodation request based on specific provisions of DAOD 5023-1, officer general specification or NCM general specification, job-based specifications or associated doctrine manuals
  • Submit to DPGR all relevant documents used for recommending a decision in respect to the LD Accommodation request
5 – Decision DPGR
  • Review all documents submitted by DPGR 4-4
  • Send to DPGR 4-4 a decision with respect to the LD Accommodation Request by completing Form DND 4458-E Part 3 including all relevant documents used to render it
DPGR 4-4
  • Submit to the Recruiting Staff or CO, by encrypted email, DPGR’s decision including all relevant documents used to render it
  • Maintain a record of DPGR’s decision, including all documents used to render it
Recruiting Staff or CO
  • Inform the individual of the decision rendered by DPGR; including any reasons for non-approval as applicable
  • Complete and sign Form DND 4458-E Part 4
  • Seek Legal Advice prior to making a decision to ensure solicitor/client privileged information is not disclosed to the individual.
  • Give the individual a paper copy of all documents used by DPGR to render the decision
  • Ensure a copy of Form DND 4458-E has been inserted in the individual’s personnel file and sent to the applicable schools for their action as required
  • Incorporate the approved LD accommodations into the recruiting or training process
  • Refer the individual to the MCC/PSO for a career counselling session or selection assessment, ONLY if recommended by DPGR in Part 3 of Form DND 4458-E (provide a copy of Form DND 4458-E to the MCC or PSO)
  • Submit to DPGR 4-4, by encrypted email, a scanned copy of Form DND 4458-E
MCC or PSO
  • Redirect the individual to a more appropriate military occupation, if any, taking into consideration the LD Accommodations approved by DPGR in Form DND 4458-E Part 3
Individual
  • Complete and sign Form DND 4458-E Part 5
  • Meet, on a voluntary basis, with the MCC/PSO for the assessment of a suitable military occupation that aligns with the authorized LD accommodations; ONLY if recommended by DPGR in Form DND 4458-E Part 3

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2025-05-27