Student Health/ Disability Form – Apprentices – repeating/refresher

If you are a student at CIT with a disability, illness or health condition, you should fill out this form so the CIT Disability Support Service (located in the Access Service) is aware of any supports you need at CIT.

Any information you give us is confidential and we will only use it with your consent.

Surname ______Course ______

First name ______ Phase/ Class ______

Home address ______Term Address ______

______

______

Mobile no ______Student Number ______

Home telephone no ______Date of birth ______

Question 1: Do you have any known disability, illness or health condition that could affect you attending lectures or examinations?

Yes No

For example:

·  Specific learning difficulties - dyslexia, dyspraxia

·  Mental health issues

·  Physical disability

·  Medical/ health condition – epilepsy, diabetes, asthma, osteoporosis, M.E.

·  Sensory - blind, visual, deaf, hard of hearing

Please give details of the type of disability, illness or health condition: ______

______

Question 2: Do you need any particular supports for your lectures or your examinations (such as extra time, separate rooms, readers and/or scribes)?

Yes No

If yes please give details: ______

______

You must also give a copy of documents that has evidence of your disability, illness or health condition to the CIT Disability Support Officer to register for any supports unless we already have a copy on file.

The CIT Disability Support Office is in the Access Service on the ground floor of the CIT Student Centre, Bishopstown. Telephone: 021 433 5107/5138 Email:
Exam supports information for FAS Apprentices

– repeat exams /refresher courses September – December 2013

Please fill out this Student health / disability form, especially if you need any supports such as a reader, scribe, separate room or extra time in your exams and submit it as soon as possible.

The closing date for repeat students to register for a reader, scribe, extra time, or separate room for FAS exams is Friday 8 November 2013.

If you register or ask for exam supports after these dates we cannot guarantee that we can arrange these for you.

·  Students who sat FAS exams at CIT before

If you got extra time, reader, scribe or separate room in your FÁS apprentice exams at CIT in the past and would like this again for your repeat exams in June 2013 please send in this form to Laura O’Rourke (see details below). You don’t need to put in your documents again.

If it is very urgent please ring or email Ruth Murphy, Disability Support, CIT Exams Office: Tel. 021 433 5049 or email:

·  Students who have never sat FAS exams at CIT

If you have never sat FÁS apprentice exams in CIT before and need a reader, scribe, extra time or separate room for your exams – you need to send this form and a copy of your documents as evidence of your difficulty or health condition, e.g. an educational psychologist’s report (not a GP letter) for dyslexia to Laura O’Rourke, Disability Support Officer, and she will confirm details with Ruth Murphy in the Exams Office who will contact you about your exams.

Laura O’Rourke’s office is in Access Service, ground floor of the CIT Student Centre in Bishopstown (open 9.30 - 12.30 and 14.00-16.30), or give the documents to one of your lecturers.

CIT Contact details:

Laura O’Rourke, Disability Support Officer- Access Service, Student Centre

Telephone: 021 433 5107 Email:

Ruth Murphy, Disability Support – Exams Office, Melbourn Building

Telephone: 021 433 5049 Email:

Carmel O’Regan, General Apprentice Exam queries- Exams Office, Melbourn Building

Telephone: 021 433 5048 Email: