Reasonable Adjustments application and notification form.
Reasonable Adjustments and Special Considerations ensure that a learner’s disability, learning difficulty or access requirements are taken into account when planning assessment. This document must be used for the following: 1.Centre Awarded Reasonable Adjustments 2.Reasonable Adjustments which need to be approved by FutureQuals. Special Consideration applications - Please contact FutureQuals Please refer to the current Reasonable Adjustment and Special Considerations Policy on the FutureQuals website.
Centre Awarded Reasonable Adjustments
Centres must complete this form when they wish to make a reasonable adjustment to an internally /centre set assessment or examination, which the FutureQuals Reasonable Adjustments and Special Consideration policy states can be made at the discretion of the centre. FutureQuals requires centres to keep a log of all reasonable adjustments, including those that have been declined.
Reasonable Adjustments Application Form
Please complete a separate form for each learner and submit with the appropriate supporting evidence at least 10 working days before the assessment date for applications that require approval by FutureQuals and at least 5 working days before a centre approved adjustment is applied.
Centre Number
*
Centre Name
*
Learner Number
Learner Name
*
First Name
Last Name
Qualification title/level
*
Centre or FutureQuals approved
*
Please Select
Centre Approved
FutureQuals Approved
Centre and FutureQuals approved
Does the reasonable adjustment apply to all units?
*
Please Select
Yes
No
If no, unit numbers to which the reasonable adjustment is to apply
Proposed assessment date:
*
/
Day
/
Month
Year
Date
Proposed assessment method(s):
*
Written questions
Oral questions
Observation
Professional discussion
Witness testimony
Learner statement
Assignment
Project
Case study
MCQ
Skills test
Other
If other, please add details here:
Details of the application:
*
Reason for application
*
Dyslexia
Dyspraxia
Dyscalculia
Other
If other or disability as defined by the Equality Act 2010, please provide additional information
Reasonable adjustment(s) requested. Please only select those for which you have supporting evidence.
*
Extra time up to 25% (please state amount below if under 25%)*
Reader
Scribe
Coloured overlay
Extra time over 25% (please state amount below)*
Other
If other, please provide details of reasonable adjustment(s) requested
*Please provide % extra time required if over or under 25%
Please upload evidence in support of the application here:
*
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Please provide details of access facilitator(s) (if applicable):
Declaration
I confirm that: The information provided is accurate;- The centre will be able to provide the arrangements requested; The reasonable adjustments will be implemented in accordance with FutureQuals’ guidance
Name
*
First Name
Last Name
Email (confirmation will be sent to this address)
*
example@example.com
Position in centre
*
Signature
*
Clear
Date
*
-
Day
-
Month
Year
Date
Centres should note that a negative decision can be appealed
(please see FutureQuals’ Appeals Policy)
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