Application Form for a Reasonable Adjustmentfor requests that need to be made to Crossfields Institute

Definition of reasonable adjustments

A reasonable adjustment is any action that helps to reduce the effect of a disability or difficulty that places the learner at a substantial disadvantage in the assessment situation. They are made to an assessment for a qualification to enable a disabled learner to demonstrate his or her knowledge, skills and understanding of the levels of attainment required by the specification for that qualification.

Reasonable adjustments must not affect the integrity of what needs to be assessed, but may involve:

  • changing usual assessment arrangements, for example allowing a learner extra time to complete the assessment activity
  • adapting assessment materials, such as providing materials in large format, Braille or audio format
  • providing assistance during assessment, such as a sign language interpreter or a reader
  • re-organising the assessment room, such as removing visual stimuli for an autistic learner, or using a different room that is more accessible
  • changing the assessment method, for example from a written assessment to a spoken assessment
  • using assistive technology, such as screen reading or voice activated software
  • providing different colour backgrounds to screens for onscreen assessments or asking for permission for copying to different coloured paper for paper-based assessments
  • providing and allowing different coloured transparencies with which to view assessment papers

Reasonable adjustments are approved or set in place before the assessment activity takes place; they constitute an arrangement to give the learner access to the programme or qualification. The use of a reasonable adjustment will not be taken into consideration during the assessment of a learner’s work.

Crossfields Institute and Centres are only required by law to do what is ‘reasonable’ in terms of giving access. What is reasonable will depend on the individual circumstances, cost implications and the practicality and effectiveness of the adjustment. Other factors, such as the need to maintain competence standards and health and safety, will also be taken into consideration.

How to request a Reasonable Adjustment

There are two routes through which a learner may be granted reasonable adjustment, these are:

  1. Reasonable adjustments permitted at the discretion of the Centre
  1. Reasonable adjustments permitted by Crossfields Institute

Please consult section 1 and Appendix 1 of the Crossfields Institute Reasonable Adjustment and Special Considerations Policy to check if approval needs to be gained from Crossfields Institute Please note: Most reasonable adjustments are made by the centre, and do not need approval from Crossfields Institute. They must be logged, and information about reasonable adjustments made must be provided to the EQA, and to the Head of Quality on request.

If the centre has any queries regarding the appropriateness of the reasonable adjustment they should contact the Crossfields Institute Head of Quality. Requests for reasonable adjustments should be submitted no later than 10 working days before the assessment.

If the request needs to be made to Crossfields Institute

  • ThisReasonable Adjustment Application Form should be used by centres to apply for reasonable adjustment on behalf of the individual learner.
  • The form should be submitted as soon as possible after registration and not later than ten working days before assessment is due to take place.
  • Crossfields Institute will respond to the Reasonable Adjustment request within 3 working days of receipt.

This application should be submitted to:

Head of Quality

Crossfields Institute

Stroud House

Russell Street

Stroud

GLOS

GL5 3AN

Or by email to:

A copy of the form, with any accompanying evidence, must be retained for at least 3 years from the end of the year to which it relates

Reasonable Adjustment Application Form

Section 1 should be completed by, or on behalf of, the learner requesting a Reasonable Adjustment
Centre Name / Click here to enter text. /
Centre Number (if known) / Click here to enter text. /
Learner Name / Click here to enter text. /
Site Address / Click here to enter text.
Qualification/Programme Title / Click here to enter text. /
Qualification/Programme Code / Click here to enter text. /
Unit Titles: / Click here to enter text. /
Unit Number/Code: / Click here to enter text. /

1. Please indicate why you are requesting a Reasonable Adjustment;

Click here to enter text.

2. Please provide details of any support or changes that are being requested:

Click here to enter text.

3. Please provide any details of supporting information, and attach a copy.Where the Centre can verify evidence of the disability or difficulty and where the implications are clear, such as for a learner with physical difficulties, profound hearing impairment or who are registered as blind or partially sighted, the Centre can confirm the need for a reasonable adjustment.

Where the implications of the difficulty are not obvious, such as for learning difficulties, or mental health difficulties, you should provide additional evidence of the effect the impairment will have on your performance in the planned assessment activities. You should provide a letter from a health or social care practitioner confirming the nature of the disability or difficulty that you have. Youmay also include information about:

  • Type of adaptive technology or support to be used
  • Previous adjustments that have been made for you (in other programmes, qualifications or centres)

Click here to enter text.

Section 2 should be completed by the tutor/assessor/programme coordinator
Tutor/assessor/programme coordinator name / Click here to enter text. /
  1. Please Provide details of the adjustments you are requesting, identifying the assessment criteria or learning outcomes of a programme or qualification to which they apply:

Click here to enter text.

Declaration:

I confirm that the information provided above is accurate:

Signature*: / Date: / Click here to enter a date. /
Position in Centre: / Click here to enter text. /
E-mail: / Click here to enter text. / Contact Number: / Click here to enter text. /

Please return the form as a Word document and not as a pdf file. Thank you

Section 3 For completion by Crossfields Institute
Reasonable Adjustment request reviewed by:Click here to enter text.
Application received date:Click here to enter a date. / Application acknowledged date:Click here to enter a date.
☐Approved ☐ Not approved
Date:Click here to enter a date.
Rationale for decision:Click here to enter text.
Action if required:Click here to enter text.

*A typed signature is acceptable if the form is received electronically from the related email address

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