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disability assessing tool
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DISABILITY ASSESSMENT FORMPlease print form and write in BLOCK CAPITALS
Completed form should be sent to us together with application form.
Surname:
First Name(s)
Date of BirthTitle (Mr, Mrs etc)
Personal details
Gender (Please tick)
About you The College needs the following information before you start your course so we can set up any support you may need
Disability: Do you consider that you have a disability? NoYes
What type of disability do you have?(Please tick)
Yes NoLearning Difficulty: Do you consider that you have a learning difficulty?
What type of learning difficulty do you have?( Please tick)
Applicant's Signature: Date:
