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    Additional Learning Support Declaration of Support Needs

    Any information you provide will help us to organise support and provide reasonable adjustments during your time studying with us.

    Student Information

    Learning Support


    ReadingWritingEnglishMathsESOLAcademic SkillsOther (please specify below)


    Extra TimeReaderScribeWord ProcessorSeparate RoomOther (please specify below)


    DyslexiaADD/ADHDVisual ImpairmentPersonal care support needHearing Impairment / D/deafMental Health ConditionMobility Need including Wheelchair UserSpeech & languageAutism Spectrum ConditionOther (please specify below)


    YesNo


    YesNo

    If Yes, please send a copy of this document to us at the email address below. If you do not have a copy, please let us know where we can get one. The more information we have, the more we can help.


    Extra LessonsTeaching support assistantCommunication Support Worker/InterpreterSpecialist teachingSpecialist equipmentOther

    Signature

    You must select the below box to proceed.

    By signing this form I agree the information is accurate

    I accept any support offered to meI refuse to accept any support offered to me

    If completing this form on behalf of the individual named above please complete below:

     

    DATA PROTECTION

    Croydon College (including Coulsdon Sixth Form) will use the personal data you have included on this form for the purpose of processing your application and for planning purposes. We will do that on the basis of the contractual arrangement with the College which you are applying for. We will retain your personal data for as long as is required for that purpose.

    We may share your data with government departments and agencies, to the extent required and permitted by law. There is further information on the web site at https://www.croydon.ac.uk/docs/default-source/default-document-library/privacy-notice.pdf about your rights, how Croydon College protects your privacy and how to contact the Data Protection Officer if you have any concerns.
     

    If you wish to discuss this form, any aspect of learning support or reasonable adjustments, you can contact us by:

    Phone: 0208 686 5700 ext. 3046
    Email: ALS@croydon.ac.uk