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Learner Reasonable Adjustment Request

Request an adjustment to teaching, learning materials, communication, assessment, scheduling, participation, digital access or another State Education arrangement where a disability, access need or other relevant barrier affects access to education.

You do not need a diagnosis just to ask for an adjustment. Tell us about the barrier and what would help. Only provide information needed to understand the request. If further information is genuinely needed, the responsible institution can ask for it through the controlled case route.

This is not a safeguarding referral form. If the information raises a safeguarding concern, the safeguarding route should also be used. An urgent access or safety need should be addressed promptly and a sensible temporary adjustment does not need to wait for the whole record to be completed where the responsible authority can safely make it.

Learner and education route

Learner name or identifier (required)

Institution / education route (required)

Programme / course / qualification, if relevant

Preferred contact or communication method

Person completing this request (required)

Relationship to learner, if not the learner

What is creating a barrier?

Describe the education activity, environment, communication method, assessment arrangement or other feature creating difficulty or disadvantage (required)

How does the barrier affect access, participation or the ability to demonstrate learning? (required)

Relevant disability, access need, communication need or other information the learner wishes to provideDo not provide unnecessary medical, safeguarding or other sensitive information.

Adjustment requested

What adjustment or change is requested? (required)

When is the adjustment needed from?

Is there a fixed assessment, session or other time-sensitive date?

No Yes

If yes, date and reason

What has helped before?

Has an adjustment or support arrangement been used previously?

No Yes

If yes, describe what helped

Is there an existing SEND support plan or other education support record relevant to this request?

No Yes

If yes, reference

Supporting information

Supporting information available, if any

Existing education record Previous adjustment decision Assessment access-arrangement information Relevant professional or external information voluntarily provided Other None / not required for initial consideration

Restricted supporting record location or referenceUse a controlled reference. Do not paste credentials or protected evidence here.

Interim adjustment

Is an interim adjustment needed while the request is considered?

No Yes

If yes, requested interim arrangement

Services and information

Government activity

Learner Reasonable Adjustment Request

Learner and education route

What is creating a barrier?

Adjustment requested

What has helped before?

Supporting information

Interim adjustment