REASONABLE ADJUSTMENT APPLICATION FORM

Students with a disability or a long-term medical condition, which may have an impact on their studies, can apply for reasonable adjustment by completing and submitting this form.

Students must apply for reasonable adjustment at the earliest opportunity upon enrolment or as soon as the condition is diagnosed to ensure that reasonable adjustments can be made available within required time frames.

For further information please refer to the Student Assessment Policy and associated Procedure available on the Australian Institute of Higher Education website: www.aih.nsw.edu.au

Please note that we will notify you of the decision within 5 working days from the date of submission.

Please contact Student Services (studentservices@aih.nsw.edu.au) if you have any further queries regarding this form.

PERSONAL DETAILS

Student ID: *

Title: *

Mrs

Other (please specify) Other (please specify)

First name(s): *

Family name: *

Sex: *

Male

Female

Date of birth (dd/mm/yyyy): * +

Phone (home/mobile): *

Email address: *

Full Address: *

City: *

State: *

Post code: *

Country: *

Course: *

REASONABLE ADJUSTMENT DETAILS

Grounds for Reasonable Adjustment: *

Evidence upload (a report from a medical practitioner is required): *

Adjustments sought: *

STUDENT DECLARATION

I declare that the information provided in this application is accurate. I have read and I understand the information about the reasonable adjustment process as outlined in the Student Assessment Policy and associated procedure.

Student's signature *

clear

Date: *

Privacy: We recommend that you read the AIH's Management of Personal Infomation Policy and associated Procedure published on our website [www.aih.nsw.edu.au]

Valid from March 2020. Details may change. Published [March 2020]. V [ 1 ].

The Australian Institute of Higher Education is listed as a Higher Education Provider on the Tertiary Education Quality and Standards Agency’s National Register of Higher Education Providers, provider number (PRV12013). ABN 70117349256. CRICOS Provider No. 03147A.

www.aih.nsw.edu.au