AccessAbility

NewStudentsRegistrationForm

PLEASECOMPLETETHISREGISTRATIONFORMANDRETURNVIAEMAILTODISABILITYSUPPORT
CALLAGHAN
Phone:(02)49216622
Fax:(02) 4921 6900
Email:
Address: RoomSC212
StudentServicesBuildingUniversityofNewcastleCallaghan NSW 2308 / OURIMBAH
Phone:(02) 43484060
Fax:(02)43484065
Email:
Address: StudentSupportUnit
UniversityofNewcastleOurimbah CampusOurimbah NSW 2258

TheUniversityofNewcastle is subject tothePrivacyandPersonalInformationProtectionAct1998andtheHealth Records andInformationPrivacyAct2002. Thepersonalinformationyouprovideinrelationtoyour registrationwill beprotectedin accordancewith the UniversityPrivacyManagementPlanandwillbeusedbythe Universityin orderto offeryoupractical assistanceandadvicerelatedtoapermanentortemporarydisabilityormedicalcondition. Thesupportandassistanceaimsto assiststudentstomeet theinherentrequirementsof theircourse whilstmaintainingacademicindependence. Ifyoudo notcompleteallthequestions onthisform,itmaynotbepossible toprocessyour registration.Yourpersonalinformationwillbe stored securely.Youmayaccessand correctyourpersonalinformation University ofNewcastlewill notdiscloseyourpersonalinformationwithoutyour consentunlesstheUniversityisundera legalobligationto doso. Bysubmittingthisapplication viayourUniversityemail account,itisunderstood

thatyouhavereadthisstatementand agreetotheuse anddisclosure ofyourpersonalinformationasdetailed inthisform.Thisform isfillable electronically.FulldetailsoftheUniversityPrivacyManagementPlancanbefoundatthefollowinglink:

Whatsupport/adjustmentsareyourequestingorhavebeenrecommendedbyyourspecialist.ThiscanalsobediscussedwiththeStudent SupportAdvisor - AccessAbilityatyourappointment:
Haveyouhadsupport/adjustmentsinpreviousstudies?Ifyes,pleaseprovidedetails:
PleaseprovideanyotherinformationyoufeelisrelevantthatshouldbeconsideredbytheStudent SupportAdvisor - AccessAbilitywhendeterminingyoursupportrequirements:
AnReasonable Adjustment Plan (RAP)outliningyoursupportandadjustmentswillbeprovidedtoyoutodistributetoyourcourseco-ordinatorsandrelevantteachingstaffandmaybeusedassupportingdocumentationforadversecircumstancesapplicationsforextensions(i.e.whenyourconditionisthereasonforyourrequest).
Informationrelatingtoyoursupport/adjustmentsmayneedtobeprovidedtootherstaffandservicesattheUniversityofNewcastle.Specificdetailsofyourconditionwillonlybeincludedifyouhavegivenconsentforustodoso.
Thisformisfillableelectronically.IfyouarereturningthisforminelectronicformatthroughyourUniversityemailaccount,asignatureisNOTrequired.
Name:
Signature: / Date:
FOROFFICEUSEONLY / RegistrationFormReceived:
-Emailed-Scanned
-Other / Date:
Updateddocumentationrequired: / YESNO / Doc.Exp.Date:
AddedtoNustar:YESNA / RAPSent(viaemail): / YES
Appointmentmade:YESNA / Date: / Tobeseenby: