Health Professional Report
SPECIAL NEEDS DOCUMENTATION FORM
To access special needs support services and reasonable adjustments from the University of New England (UNE), students
are required to provide appropriate medical documentation from an accredited health professional.
An accredited health professional ONLY should complete this form and supply current legible information together with
recommendations for adjustments. The information provided will remain confidential by UNE and will be used by the Special
Needs Office to negotiate reasonable adjustments in relation to academic support for the student.
STUDENT DETAILS
Full Name
Student No.
Course
QUALIFIED HEALTH PROFESSIONAL
Full Name
Position
Date of Report
This report must be accompanied by the accredited health professional’s stamp or business card including registration
number and contact details.
(Please use stamp)
DISABILITY/HEALTH CONDITION INFORMATION (to be completed by the qualified health professional)
TYPE
(please tick all that
apply)
Hearing impairment
Vision impairment
Physical disability
Mental health condition
Learning disability
Medical condition
Neurological Disorder
Other
Permanent
Temporary
DIAGNOSIS
DURATION
If temporary, must include a review date:
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THE UNIVERSITY OF NEW ENGLAND TEACHES IN ORAL AND WRITTEN ENGLISH. MOST TEACHING MATERIALS
ARE PROVIDED TO STUDENTS USING AN ONLINE SYSTEM THAT IS INTERNET BASED. SOME UNITS STUDIED ARE
COMPLETELY ONLINE AND CANNOT BE MADE INTO HARD COPY
Does the student’s disability/health condition prevent them from participating in online teaching environments, perusing
online teaching materials or interacting in online teaching discussions?
No
Yes
If ‘yes’ please comment on the limitations based on the students disability:
If ‘yes’ does the student require hard copy of online teaching materials?
Size
A4
A3
No
Yes
Colour (e.g. sand):
If hardcopy is required, then based on the student’s disability/health condition alone, is the student able to print the study
material themselves?
No
Yes
Does the student’s disability/condition prevent them from using hard copy text books?
No
Yes
If ‘yes’, please comment on the limitations based on the students disability:
Does the student use assistive technology e.g. ‘Dragon Naturally Speaking’, ’Read &Write Gold’, ’Jaws’ etc?
No
Yes
If ‘yes’, please list the type used?
Students will be expected to have developed skills in the use of their technology before commencing their studies at UNE.
If applicable, in what format do text books need to be in for use with the assistive technology:
PDF
Word
STUDENTS WILL BE REQUIRED TO EITHER ATTEND LECTURES IF ON-CAMPUS, OR LISTEN TO PODCASTS ONLINE IF THEY
ARE OFF CAMPUS
Does the student have a hearing impairment that will prevent them from hearing aural materials?
No
Yes
If ‘yes’, all aural online material (podcasts) will be transcribed word for word and provided to the student in MS Word format.
If attending lectures in person, does the student have a laptop capable of displaying instant captioning?
No
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Yes
Does the student have a disability/health condition that prevents them from taking notes in lectures?
No
Yes
If ‘yes’ then please comment on the disability/health condition and limitations:
If answered ‘Yes’ UNE may provide a digital recorder for the student so they are able to record lectures and take notes at their
own leisure. Where a recorder cannot be used in lectures (e.g. due to safety reasons) then a scribe may be allocated to assist
the student.
MOBILITY
Does the student require assistance with accessibility (level access, ergonomic seating, specialised vehicle for field trips etc.)?
No
Yes
If ‘yes’, please provide details:
EXAMINATIONS ARE AN IMPORTANT PART OF THE LEARNING PROCESS. ALL STUDENTS ARE EXPECTED TO PARTICIPATE
IN EXAMINATIONS. IF THE STUDENT’S HEALTH CONDITION HINDERS THIS, THE UNIVERSITY MAY MAKE REASONABLE
ADJUSTMENT.
Is the student able to undertake exams at examination centres:
No
Yes
If ‘No’ please provide comment on reasons in respect to the student’s disability/health condition. Students unable to attend
examination centres may be required to undertake alternative forms of assessments.
If the student is able to undertake exams at the examination centres, please indicate below what reasonable adjustments
may be suitable for this student based on their disability/health condition (please answer all questions):
Extra time to complete exams and/or take rest breaks:
Separate room or small group:
No
Yes
Level access to examination centre:
No
Yes
Use of computer during exams:
No
Yes
No
Yes
Use of own assistive technology during exams (Dragon, Read & Write Gold etc.):
Use of a reader during exams:
No
Yes
Use of a scribe during exams:
No
Yes
Seated close to toilets during exams:
No
Yes
Permission to administer medication during exam rest breaks:
Enlarged examination paper:
No
Yes
Coloured examination paper:
No
Yes
No
No
Yes
Yes
Colour (e.g. sand)
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Other adjustments deemed appropriate:
Other relevant information (please include recommendations where it is identified that a student requires a health
management plan to manage a health crisis e.g. epilepsy, heart conditions, mental health conditions etc.):
In some instances we may require more information to identify reasonable adjustments and may need to contact you. Has
the student consented to future contact and the release of medical information to UNE for the purposes of identifying and
putting in place such adjustments?
No
Yes
Signature of Health Professional
Please return completed form to:
Special Needs Office
C33 Lamble Building – West Wing
University of New England
Armidale NSW 2351
or submit through AskUne
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Date