REASONABLE ADJUSTMENT FORM "*" indicates required fields Course*CHC33021 - Certificate III in Individual SupportCHC30121 - Certificate III in Early Childhood Education and CareCHC43015 - Certificate IV in Ageing SupportCHC40221 - Certificate IV in School Based Education SupportCHC43121 - Certificate IV in Disability SupportCHC43415 - Certificate IV in Leisure and HealthCHC43315 - Certificate IV in Mental HealthCHC43515 - Certificate IV in Mental Health Peer WorkCHC42021 - Certificate IV in Community ServicesCHC43215 - Certificate IV in Alcohol and Other DrugsFNS40222 - Certificate IV in Accounting and BookkeepingCHC53315 - Diploma of Mental HealthCHC50221 - Diploma of School Age Education and CareCHC53415 - Diploma of Leisure and HealthCHC52021 - Diploma of Community ServicesCHC50121 - Diploma of Early Childhood Education and CareCHC62015 - Advanced Diploma of Community Sector ManagementBSB60420 - Advanced Diploma of Leadership and ManagementName* First Last Phone*Email* Preferred Delivery Mode*Select oneClassroomBlendedWorkplaceSuburb or Postcode*1. Please describe your disability or long-term medical condition:*2. How does this condition impact your studies? (Check all that apply)* Learning difficulties Social interaction challenges Communication difficulties Physical limitations Other Other (please specify):*3. What specific adjustments do you require? (Check all that apply)* Extended time for assignments/exams Alternative format materials (e.g., large print, audio) Assistive technology Physical accessibility accommodations Flexible attendance policy Other Other (please specify):*Assistive technology (please specify):*4. Please provide additional details about the adjustments you need:*Consent* I authorise the Hammond Institute to use the information provided in this form to assess the adjustments listed. I understand that under the Disability Standards for Education Act 2005 that the Hammond Institute has the right to refuse the adjustment if it is deemed unreasonable or unable to accommodate your needs.Declaration* I declare that the information provided in this form is true and correct to the best of my knowledge.Signature*Date* DD slash MM slash YYYY
