Disability Support Application Form
Section 1: Personal Information
Full Name
Student ID Number
Email Address
example@example.com
Phone Number
Program of Study
Please Select
CHC30121 Certificate III in Early Childhood Education and Care
CHC50121 Diploma of Early Childhood Education and Care
BSB50120 Diploma of Business (Digital and Data)
BSB60420 Advanced Diploma of Leadership and Management
BSB80120 Graduate Diploma of Management (Learning)
BSB50820 Diploma of Project Management
BSB60720 Advanced Diploma of Program Management
ICT50220 Diploma of Information Technology (Business Analysis)
ICT60220 Advanced Diploma of Information Technology
BSB40820 Certificate IV in Marketing and Communication
BSB50620 Diploma of Marketing and Communication
BSB60520 Advanced Diploma of Marketing and Communication
General English
Section 2: Disability Information
Nature of Disability
Physical Disability
Learning Disability
Sensory Disability (Hearing, Vision, etc.)
Psychological Disability
Chronic Illness
Other (Specify)
If Other, Please Specify
Description of Disability
How Does Your Disability Affect Your Studies?
Section 3: Support Required
Type of Support Requested
Academic Adjustments (e.g., exam modifications)
Assistive Technology
Physical Accessibility Adjustments
Personal Support Services
Other (Specify)
If Other, Please Specify
Describe the Support Needed
Preferred Support Method
In-Person
Online
Phone
Section 4: Supporting Documentation
Upload Supporting Documents
Browse Files
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Choose a file
Please upload any relevant documents to support your application (e.g., medical certificates, diagnostic reports).
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Section 5: Consent and Agreement
Consent for Verification
I consent to Rosehill College verifying the information provided and contacting the relevant professionals for further details if required.
Agreement to Privacy Policy
I have read and agree to Rosehill College’s Privacy Policy.
Signature
Date
-
Month
-
Day
Year
Date
Section 6: Additional Information
Additional Comments or Requests
Submit
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