Higher Education Reasonable Adjustment Form
The London Institute of Banking & Finance wants to recognise your individual needs and is committed to making reasonable adjustments to enable
you to participate fully in academic life. In order for us to assess your requirements, please complete the following information.
Requests and supporting evidence should be made at least eight weeks prior to the date when the adjustment will need to be in place.
We may not be able to apply your adjustments if received after this deadline.
The London Institute of Banking & Finance is a registered charity, incorporated by Royal Charter.
YOUR DETAILS
LIBF number (If known) ____________________________________________________ Title (Mr/Mrs/Ms etc) _____________________________________________
First name(s) / Given name(s) ____________________________________________________________________________________________
L
ast name / Family name _______________________________________________________________________________________________
Date of birth*
(DD/MM/YYYY) ____________________________________________________ Gender Male
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Female
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*A date of birth is compulsory to activate your online account.
YOUR DETAILS
YOUR DETAILS
Email address* _______________________________________________________________________________________________________________________
Please provide a telephone number we can use to contact you if necessary:
Telephone no. ______________________________________________ Mobile no.
(if different from Telephone no.) _________________________________________
*
Please note that having a valid email address is a compulsory requirement of study.
CONTACT DETAILS
YOUR DETAILS
Address ________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________
Postcode / Zipcode
_____________________________________________________ Country _____________________________________________________
ADDRESS DETAILS
PLEASE TICK THE BOXES THAT YOU FEEL BEST DESCRIBE YOU
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You have a social / communication impairment such as Aspergers syndrome
n
You are blind or have a serious visual impairment
n
You are deaf or have a serious hearing impairment
n
You have a speech impairment
n
You have a long standing illness or health condition such as cancer or epilepsy
n
You have a mental health condition, such as depression or anxiety disorder
n
You have a specific learning difficulty such as dyslexia, dyspraxia or ADHD
n
You have physical impairment or mobility issues
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You have a disability, impairment or medical condition that is not listed above
We require evidence from a medical professional that confirms your disability or condition eg Doctor’s / Consultant’s letter, Educational
Psychologist or Specialist Teacher’s Assessment report. Ensure your evidence is provided on official header paper and it is dated. It is
beneficial if your evidence specifies the reasonable adjustment(s) required and for how long the reasonable adjustment(s) is needed for.
Some evidence may need to have a recent date, but evidence within the last 5 years may be suitable for permanent conditions. If you are
unsure what documents to provide please contact us for further advice. We may request further supporting evidence.
If you are applying for Disabled Students’ Allowances (DSA) they may have other evidence requirements, speak to your Programme
Team if you need help with this application.
Is this a permanent impairment? Yes
n
No
n
What date the impairment will end? __________________________________________________________________________________________________________
Please give any additional information below that you feel may be relevant:
YOUR DETAILS
Assistance with evacuating a building quickly in an emergency
n
Assistance in opening heavy doors
n
Level access to buildings (via lift or ramp)
n
Ergonomic Furniture (including seating / desks)
n
Reserved area for wheelchair / mobility scooter
n
Easy access to bathroom facilities
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Reserved seating near front / light source / window / exit
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Loop / Infrared system for hearing aid
n
Extra time
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Use of a computer
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A reader
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A scribe to transcribe your answers
n
A separate room from the main examination room
n
Rest or nutrition breaks
n
Examination paper produced in an alternative format (eg large type face)
n
Please specify:
Learning materials required in advance
n
Learning material required in an alternative format, please provide details on what format you need (eg large type face)
n
_________________________________________________________________________________________________________________________________________
Loop / Infrared system for hearing aid
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Permission to record lectures – own equipment to be supplied
n
By requesting permission to record you agree recordings will be for your own study purpose, not to upload or share them with
others & to delete them after completion of the module.
(Students can apply for a Disabled Students Allowance for a Specialist equipment allowance. Visit www.gov.uk for further information.)
If the support you require is not listed above, please provide details below so that your request may be considered.
Access to the physical environment for examinations Tick
Requirements for Support
Listed below are various types of possible support available to students. Please indicate your requirements below:
Examination arrangements
Additional information
Lectures
NB11/19
Please send completed forms to:
Full-time and Postgraduate
Programme Team
The London Institute of Banking & Finance
25 Lovat Lane,
London,
EC3R 8EB
Email: reasonableadjustments@libf.ac.uk
Part-time Programme Team
The London Institute of Banking & Finance
4-9 Burgate Lane
Canterbury
Kent
CT1 2XJ
Email: reasonableadjustments@libf.ac.uk
Apprenticeship Programme Team
Email: reasonableadjustments@libf.ac.uk
W
e 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
d
ata to third parties, storage, retention and how to amend your personal data, can be found within our Privacy Notice
(www.libf.ac.uk/privacy).
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Please tick the box if you give consent for your lecturers to be advised of all your specific educational needs/medical condition and
reasonable adjustments so they can support you in your studies. Please note some reasonable adjustment information must be
shared with appropriate lecturers to implement certain reasonable adjustments listed above.
YOUR PERSONAL DATA
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I declare that the information contained in this form is true and accurate.
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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.
Signed______________________________________________________________________ Date ________________________________
Please note that all unsigned forms will be returned and will result in a delay in the processing of your enquiry.
The reasonable adjustment(s) applied to your teaching experience and assessment mitigate disadvantage you may incur from educational
needs/medical condition. Thus the marking policy will be fairly applied to your assessment(s) to ensure you have access to a learning
experience comparable to that of your peers.
DECLARATION
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