Reasonable Adjustment Form for Corporate and
Professional Qualifications
It is important to us that all our students have the opportunity to demonstrate their true level of ability during an assessment.
To make an application, please read the Reasonable Adjustments Policy and Procedure for Corporate & Professional Qualifications and then
email your completed form, together with supporting evidence, at least 8 weeks prior to the date when your adjustment will need to be in place.
We may not be able to apply your adjustment 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) ____________________________________________________________________________________________
Last 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
Business address
________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________
Postcode / Zipcode
_____________________________________________________ Country _____________________________________________________
Home address ________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________
Postcode / Zipcode
_____________________________________________________ Country _____________________________________________________
Please indicate which address you would prefer us to use for postal correspondence: Business
n
Home
n
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 long standing illness or health condition such as cancer, HIV 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 a physical impairment or mobility issues
n
You have a disability, impairment or medical condition that is not listed above
We require a statement from a medical professional that confirms the nature of your disability eg Doctor’s or Consultant’s letter,
Educational Pyschologist's or Specialist Teacher's Assessment report. If you are unsure what documents to send please contact us for
further advice. We may request further supporting evidence and in all cases, you should only send photocopies or scans as we are unable
to return original documents
Is this a permanent impairment? Yes
n
No
n
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
n
Reserved seating near front / light source / window / exit
n
Loop / Infrared system for hearing aid
n
Extra time
n
Use of a word processor
n
A reader
n
An amanuensis (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:
YOUR DETAILS
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
YOUR DETAILS
We 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
data to third parties, storage, retention and how to amend your personal data, can be found within our
Privacy Notice (www.libf.ac.uk/privacy).
YOUR PERSONAL DATA
YOUR DETAILS
n
I declare that the information contained in this form is true and accurate
n
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 ________________________
DECLARATION
Please send this form to:
Student Support Services
The London Institute of
Banking & Finance
4-9 Burgate Lane
Canterbury
Kent
CT1 2XJ
Tel: +44 (0) 1227 818609
Email: support@libf.ac.uk
MS05/18
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