Section C
Evidence of Disability
Form 2015
CAO OFFICE USE ONLY:
Distributed by the CAO on behalf of Higher
Education Institutions (HEIs)
Instructions for completing this form:
This form has a dual purpose. Some Higher Education Institutions (HEIs) operate individual
supplementary admissions routes for students with disabilities. This form is used by HEIs to provide
verification of the applicant’s disability and helps to determine appropriate supports at third level.
A number of colleges and universities operate a joint supplementary admissions route known
as DARE. This form is also used by DARE to help assess an applicant’s eligibility for DARE. DARE
requires an applicant to submit evidence of disability as part of his/her application. An applicant’s
evidence of disability documentation is used by DARE to establish whether or not he/she meets
DARE’s eligibility criteria. In addition it is used by DARE colleges and universities to determine
the kinds of supports an applicant might need in college. An application will not be complete until
an applicant provides evidence of his/her disability on 1 April 2015. More information on DARE is
available from www.accesscollege.ie/dare.
Steps to completing this form when applying to DARE
The table below provides a guide to submitting evidence of your disability.
Applicants who are unsure about the evidence that they need to supply can contact any
member of the DARE team. Contact details for DARE are listed in the DARE Application Guide
and on www.accesscollege.ie/dare.
Applicants who are submitting the Section C Evidence of Disability Form 2015 should make sure:
 it is has been completed and signed by the appropriate professional AND
 it contains the stamp of the appropriate professional or is on headed paper or is accompanied by
a business card AND
 the appropriate professional has filled in all parts of the form AND
 the form is legible.
Remember
 The online Supplementary Information Form must also be completed and ticked for DARE where
an applicant is applying for DARE.
 Evidence completed by a GP or support organisation is not accepted as verification of a disability.
 Send the original Evidence of Disability form by post. Faxed/emailed documents are not accepted.
 Keep a photocopy of Evidence of Disability documentation for your personal records and don’t
forget to retain proof of postage.
DARE applicants must send the Evidence of Disability to:
CAO, Tower House, Eglinton Street, Galway by 17:15 by 1 April 2015.
1/6
Guide to Providing Evidence of Disability
TYPE OF
DISABILITY
TYPE OF
DOCUMENTATION
APPROPRIATE
PROFESSIONAL
REQUIRED AGE
OF REPORT
Autistic Spectrum
Disorder (including
Asperger’s
Syndrome).
Evidence of Disability
Form 2015
OR
Existing report.
Consultant Psychiatrist
OR
Psychologist
OR
Neurologist
OR
Paediatrician.
No age limit.
Attention Deficit Disorder
(ADD) / Attention Deficit
Hyperactivity Disorder
(ADHD).
Evidence of Disability
Form 2015
OR
Existing report.
Consultant Psychiatrist
OR
Psychologist
OR
Neurologist
OR
Paediatrician.
Must be less than three
years old i.e. dated after
1 February 2012.
Blind/Vision Impaired.
Evidence of Disability
Form 2015
OR
Existing report.
Ophthalmologist
OR
Ophthalmic Surgeon.
No age limit.
Deaf/Hard of Hearing:
Students may apply
under one of the
following categories:
(A) Applicants who have
an Audiogram
(B) Applicants who attend
a School for the Deaf
(C) Applicants with
a Cochlear Implant.
Evidence of Disability
Form 2015
OR
Existing report.
(DARE does not accept
reports from high street
retailers).
(A) Applicants who
have an audiogram:
Diagnostic/Clinical
Audiologist registered
with the Irish Academy of
Audiologists (IAA)
(B) Applicants who attend
a School for the Deaf:
Principal of School for
the Deaf
(C) Applicants with a
Cochlear Implant: Ear,
Nose & Throat (ENT)
Consultant
OR
Cochlear Implant
Programme Co-ordinator.
No age limit.
Developmental
Co-ordination Disorder
(DCD) - Dyspraxia/
Dysgraphia.
Full psycho-educational
assessment
AND
Psychologist
AND
Psychologist’s
Report must be less than
three years old i.e. dated
after
1 February 2012.
Evidence of Disability
Form 2015
OR
Existing report.
Mental Health Condition.
2/6
Evidence of Disability
Form 2015
OR
Existing report.
Occupational Therapist
OR
Neurologist.
No age limit Occupational
Therapist’s or
Neurologist’s report.
Consultant Psychiatrist on
Specialist Register. We will
consider your application
for DARE once we receive
a diagnosis of a significant
and enduring mental
health condition which
impacts on daily function.
Must be less than three
years old i.e. dated after
1 February 2012.
TYPE OF
DISABILITY
TYPE OF
DOCUMENTATION
APPROPRIATE
PROFESSIONAL
REQUIRED AGE
OF REPORT
Neurological Conditions
(including Epilepsy, Brain
Injury, Speech and
Language Disabilities).
Evidence of Disability
Form 2015
OR
Existing report.
Neurological Conditions:
Neurologist
OR Other relevant
Consultant.
No age limit.
Speech & Language
Disabilities: Speech and
Language Therapist.
Physical Disability.
Evidence of Disability
Form 2015
OR
Existing report.
Significant On-going
Illness.
Evidence of Disability
Form 2015
OR
Existing report.
Orthopaedic Consultant
OR
Other relevant consultant
appropriate to the
disability/condition.
No age limit.
Diabetes Type 1:
Endocrinologist
OR
Paediatrician.
Must be less than three
years old i.e. dated after
1 February 2012.
Cystic Fibrosis (CF):
Consultant Respiratory
Physician
OR
Paediatrician.
Gastroenterology
Conditions:
Gastroenterologist
Other Conditions:
Relevant Consultant/
Specialist in area
of condition.
Specific Learning
Difficulty (including
Dyslexia & Dyscalculia).
Full psycho-educational
assessment.
Psychologist.
Must be less than three
years old
i.e. dated
after 1 February 2012.
Please complete all sections below in TYPE or BLOCK capitals:
1. Applicant Details
Title and Full Name of
Applicant
Date of Birth
CAO Number
3/6
3/6
2. Medical Consultant/Specialist
Name and Title of
Consultant/ Specialist
Phone (including area
codes)
Position/Professional
Credentials
Date of Report
Date of diagnosis/onset of
disability
3. Disability Information
Disability Type (please tick primary disability):
Autistic Spectrum Disorders
(including Asperger’s Syndrome)
ADD/ADHD
Blind/Vision Impaired
Deaf/Hard of Hearing
DCD-Dyspraxia/Dysgraphia
Neurological Conditions (including
Brain Injury, Speech and Language
Disabilities)
Physical Disability
Significant Ongoing Illness
Specific Learning Difficulty
(including Dyslexia & Dyscalculia)
Mental Health Condition
Please state the specific name of the disability (if relevant):
Please state if there are any other disabilities:
4. Outline the history and detail of the disability. Confirm if the condition is congenital or
acquired; and if it is permanent, temporary or fluctuating.
4/6
4/6
5. Will the condition remain static, have periods of relapse/remission or is it progressive?
6. Describe measures currently being taken to treat the disability (e.g. medication,
therapy, etc.)
7. If the applicant is Blind / Vision Impaired, state the visual aculty scores, field of vision
loss, loss of near vision, central vision or peripherial vision where appropriate.
8. How does the disability/medical condition impact on the applicant’s ability to study
and participate in school/college (e.g. impact on school attendance, ability to engage
with the curriculum, examination performance, etc.)?
5/6
5/6
9. What recommendations would you make for reasonable accommodations/supports to
enable equal participation in Higher Education (e.g. adaptive equipment, examination
accommodations, etc.)?
/
Consultant’s signature
Official Stamp: This form must
be completed and signed by the
appropriate professional. In
addition it should be stamped
or accompanied by a business
card or headed paper.
6/6
6/6
Date
/