Reasonable Adjustment Form

Teachers Number* Teachers Name*

Candidate Number* Candidate Name*

Qualification Title* Access Arrangement Requested*

Details Of Supporting Evidence* Please Provide Details Of Supporting Evidence. This May Include: - The Teacher's Assessment Of The Candidates needs -History of provision for the candidate within the teacher - Medical Certificate - Psychological Or Other Professional Assessment Report

Declaration: I am satisfied that the information provided in this form is accurate. I fully support the application and confirm that the candidate is/will be appropriately entered for the examination(s)/course(s) concerned and will be able to demonstrate the assessment objectives required by the specification.

I agree to the above *

Teachers Name Access Arrangement Requested

Email* I agree to the privacy policy *

Notes on the completion of the Reasonable Adjustment Form

Please fill in a separate form for each candidate and qualification. In the box Reason for application, please state precisely the nature of the disability or indisposition and its effects in relation to the assessment (e.g. cerebral palsy affecting movement of hands). The teacher is advised, wherever possible, to consult a specialist advisory service or other external service on the most appropriate arrangements for the candidates concerned and then consider their advice in the light of the course specifications. Please specify any information/evidence enclosed with the application, which will assist our understanding of the case. Medical or other appropriate evidence will not always be required but must be provided for cases that the teacher is unable to verify to the satisfaction of the awarding body. The teacher must agree to the declaration shown on the form and provide their name and the date agreed.