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
n
Female
n
*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
n
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
n
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:
