Student's First Name *
Student's Last Name *
Student's Preferred Name:
Year Group:
Student's Date of Birth: *
Please Select: *

Does the above named person have any special educational needs requiring special educational provision to be made for them as a result of a learning difficulty? 

A student has a learning difficulty if he/she:

  • Has a significantly greater difficulty in learning than the majority of students of the same age; or
  • Has a physical or mental disability which prevents or hinders the student from making use of educational facilities of a kind generally provided for students of the same age in the school.
If yes, please list full details below, including what time allowance the student is entitled to (if known)
Please upload any relevant supporting documentation here:
(e.g. educational psychologist's report/medical documentation)

Please read the statement and sign below, which will be used in place of your signature.

Upon enrolment of the student, I authorise the college to release any of this information either to medical personnel in the event of an emergency or to Examination Boards in the event of application for extra time, access arrangements, or other special consideration in an examination.

Relationship to Student: *
Full Name: *
Initials:
(Signifies consent) *

Please leave the next box blank or your submission will not be accepted: