Reasonable Adjustment Request Form

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Reasonable Adjustment Request Form

Specially Abled learners requiring an adjustment are invited to submit a request by completing the Reasonable Adjustment Request Form:

Full Name of Learner

Registered Email ID

Phone Number (Optional)

Course Name

Course Fee Receipt Number/ID

Nature of Disability, Medical Condition, or Specific Need (Please briefly describe the nature of your disability, condition, or any specific needs affecting your learning experience.)

Adjustment(s) Requested (Please describe the specific adjustment(s) you are requesting to support your access to and participation in the course.) Examples: Extra time for final quiz, alternative assessment format, early access to materials, assistive technology use, etc.

(Please (Please alternative

Additional Information (Optional) (Use this space to provide any further information that may help us assess your request.)

Declaration

I declare that the information provided in this form is accurate and complete. I understand that Scholastia will treat my information confidentially and will use it solely to assess and provide reasonable adjustments to support my learning.

Please find our Reasonable Adjustment Policy here.

Reasonable Adjustment Request Form

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