Reasonable Adjustments Request Form

This form is for Centres to complete with any Reasonable Adjustment requests.

Please complete all fields and submit the form no later than ten working days before the assessment

Learner(s) ID number(s) to whom you wish to apply a Reasonable Adjustment*

Enter Cohort IDs or Learner Numbers. Please do not include learner names. Click + sign to add more rows.

Qualification Number*
Qualification title (learner is registered on)*
Reason for application*
Access arrangement requested*
Details of supporting evidence*
Please provide details of supporting evidence below, this may include: • The centre’s assessment of the learner’s needs • History of provision for the learner within the centre • Medical certificate • Psychological or other professional assessment report
Please upload supporting evidence, if relevant
Drop files here or

Max. file size: 50 MB.
DECLARATION: I am satisfied that the information provided on this form is accurate. I fully support the application and confirm that the learner is/will be appropriately entered for the examination(s)/course(s) concerned and will be able to demonstrate the assessment objectives required by the specification.*
First Last
Date*

Day
Month
Year
Email*
We will email you confirmation of this request.
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