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Page 1: Accessibility Service Registration Form Accessibility... · Accessibility Service Registration Form . ... Summary details about your situation. 11 . Student Status: ... Are you receiving

Accessibility Service, Student Services Unit UTS, Building 1, Level 6, 15 Broadway, Ultimo. Email: [email protected] Post: P.O. Box 123, Broadway, NSW 2007 Ph: + 61 2 9514 1177

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Accessibility Service Registration Form Welcome to the Accessibility Service.

The Accessibility Service is the University’s central contact point for all students with a health condition or one or more disabilities, to request assistance, support and reasonable adjustments. Students requesting support are required to register with Accessibility. Health conditions and disabilities include a wide range of conditions such as learning disabilities, ADHD, ongoing medical conditions and mental illness, as well as temporary physical injuries.

The Accessibility Service does not deal with:

• students with short term illness, that can be accommodated via the Special Consideration process.

• students who have carer responsibilities or who are pregnant. Students with these circumstances can liaise directly with their Faculty Academic Liaison Officer (ALO), or you are also welcome to book in with the Counselling Service for additional support. More information is available at www.ssu.uts.edu.au/carers/.

Please read the following pages and complete the series of questions before your first appointment with a Accessibility Consultant (AC). Information provided will:

• enhance the effectiveness and helpfulness of first appointments,

• provide useful background information that will assist the Accessibility Service to understand your situation and needs.

Should you have any concerns about the questionnaire, please raise them with your AC. You can also email any questions to [email protected].

Your responses to this questionnaire will become part of your individual client file, which will be held securely in line with the University’s recordkeeping policy and procedures.

Go to www.accessibility.uts.edu.au for further information about the Accessibility Service.

Please be aware of your Rights and Responsibilities included with this form.

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Registration with the Accessibility Service

To complete your registration with the Accessibility Service you must:

1) Sign your acknowledgement of the Rights and Responsibilities included in this Registration form

2) Provide the required documentation from a relevant, registered Health Professional

3) Attend an appointment with an Accessibility Consultant (AC), who will consult with you about your needs and determine via consultation with you:

• eligibility to register on a permanent or temporary basis;

• appropriate support services;

• recommendations for reasonable adjustments for participation, assessments and examinations to the appropriate Faculty or Unit for consideration/approval.

4) Complete the Accessibility Service Access Plan with your Accessibility Consultant.

Supporting documents Information required All students accessing the Accessibility Service are required to provide information from a relevant Health Professional about how the impact of their disability / ongoing medical condition affects their participation and access to learning. Information required includes:

• An explanation of the nature or diagnosis of disability/medical condition.

• How the disability / medical condition impacts on the students study e.g. lectures, tutorials, laboratories, class participation, attendance, ability to undertake private study, exams, quizzes, assignments, presentations, online activities, group work and clinical/practical - work based learning environments.

• Please consider: reading, writing, speaking, listening, cognitive processing, mobility, concentration, memory, fatigue.

• Whether the disability / medical condition impacts intermittently, fluctuates or is episodic, what are the impacts and/or triggers on the students study during these times and usual timeframe until recovery.

• Any side effects from medication that impacts on study.

• The expected duration of the current impacts as outlined above e.g. permanent, temporary (specific dates) or date until this documentation is valid.

• Recommendations to the University to assist the students study e.g. specific exam provisions, length of assignment extensions, alternatives to particular assessment types.

How to obtain supporting documents/information The required information can be provided in one of the following ways:

• A letter from a relevant, registered health professional (e.g. medical Doctor, Counsellor), on letterhead, dated and signed, and including the required information detailed above.

• Completion of the Health Professional Documentation form by the nominated Health Professional, and/or

• Educational / psychometric assessment report, diagnosing learning disabilities.

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Summary information Please answer the following questions, ticking the box where appropriate. The following questionnaire should only take 5 minutes to complete. 1. Name: 2. Date: 3. Student ID number: 4. Contact phone no. 5. Mobile: 6. Student email address: @student.uts.edu.au 7. Course: 8. Faculty: Section 1. Your first appointment details 9 Date of first appointment:

10 Specify name of assigned Accessibility Consultant:

Section 2. Summary details about your situation 11 Student Status:

☐ Undergraduate ☐ Postgraduate ☐Exchange ☐ Prospective student

12 The following questions will help determine if you are eligible for referral to other programs and services within the Accessibility and Financial Assistance Service. These questions are not mandatory. What is your student fee status?

☐Commonwealth supported ☐Domestic fee paying ☐International What was your basis of Admission to the University: ☐ HSC / state equivalent ☐ TAFE ☐Australian University studies ☐ Overseas University studies ☐ Insearch ☐ Other If you are a local student, did you apply through any of these schemes in addition to your UAC application: ☐Educational Access Scheme / inpUTS ☐Schools Recommendation Scheme ☐Special Admissions If you receive Centrelink benefits, please select which from the following:

☐ Disability support pension

☐ Youth allowance / Austudy / Abstudy / Newstart

☐ Carer payment / Parenting payment

☐ Not relevant / N/a

Are you receiving an Equity Scholarship? ☐ Yes ☐ No ☐ Unsure

Do you identify as Australian Indigenous? ☐ Yes ☐ No

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13 How did you find out about the UTS Accessibility Service: ☐ Referred by Academic Liaison Officer (ALO)

☐ Referred by other Students Services Unit service eg. Counselling, Medical, Careers, Helps

☐ Faculty Academic or Administrative staff

☐ Student Centre

☐ External

☐ website / advertising / word of mouth / direct email from Accessibility following UAC application

Have you applied or receiving services from NDIS:

☐ Yes – receiving ☐ No – and interested in applying

☐ Yes – applied ☐ No – and not interested in applying

14 Please indicate which service/s you are requesting:

☐ Exam provisions

☐ Extension on assessments

☐ Alternative assessments

☐ Inclusive practices to assist with my participation in class

☐ Strategies to assist in managing the impacts of my health condition / disability upon study

☐ Assistive Technology (TextHelp Read & Write Gold, Zoomtext, Dragon)

☐ Access to quiet study spaces / purpose study spaces on campus

☐ Library access – extended loans and assistance

☐ Ergonomic Furniture / Equipment

☐ Alternative formats

☐ Notetaking

☐ Auslan interpreters

☐ Supply of texts in alternative format (students with print disabilities)

☐ Accessible parking

☐ Travel concession - if studying part-time due to impacts of disability/medical condition

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Your Rights and Responsibilities

Privacy 1) In becoming a client of the Accessibility Service, personal and health information will be collected

from you to assess your eligibility to register with Accessibility, to facilitate and assess approved accommodations and support services for you whilst you remain a client, and to make recommendations of assessment arrangements for Faculty consideration / approval (e.g. assignment extensions, exam provisions, alternative types of assessment etc.) with your consent. Information and supporting documents may also be requested and collected from other parties for this purpose, with your consent.

2) All staff working in or for the Accessibility Service, including the Student Services Unit (SSU)

Director in his management/oversight role, will have access to client records to ensure continuity of service, completion of routine administrative activities, and for debriefing/case discussion and handovers between Accessibility staff where required.

3) Information held will be used to plan and review service delivery. Information will also be used for

funding, using student ID only; and statistical reporting, using de-identified information to Federal and State Government.

4) Once approved accommodations and support services are defined, information will be exchanged

between relevant areas of UTS to facilitate the agreed accommodations. This exchange will only occur with separate consent from you in addition to these rights and responsibilities.

5) Client information will not be disclosed beyond the above requirements unless:

a) you have provided consent for information to be shared or disclosed (or consent has been received from a person with legal authority to act on your behalf);

b) the disclosure is considered necessary to lessen or prevent a serious and imminent risk to life or health of yourself or another person, or a threat to public health or public safety. Where a risk may not be imminent, but there are valid concerns for the health and safety of staff or students, information may be disclosed to staff responsible for campus security and wellbeing.

c) we are required by law to disclosure the information (e.g. mandatory reporting of a serious crime, or Australian Health Practitioner Regulation Agency (AHPRA) mandatory reporting obligations1 ).

6) You can request access to information held about you by contacting the Accessibility Service. 7) The Accessibility Service protects client personal and health information. Information collected about

you will be stored securely and only retained for the above purposes and to satisfy legal retention requirements before it is confidentially destroyed.

8) Certain Student Services Unit services/programs adopt a collaborative approach to enhance service

delivery for students. This enables more cohesion between the services when working with students, a smooth transition and referral between services, and minimises the duplication of processes and documentation provision. Staff may be working across various services/programs as part of this collaborative approach.

The services below share an appointment system. As such, each of these Services will share [UTS] details regarding the appointments booked by students.

The Student Service Unit services involved are:

• Accessibility

1 See the Course Related Work Experience Vice-Chancellor's Directive and the related Course Related Work Experience: Procedures for Reporting Obligations to the Australian Health Practitioner Regulation Agency (AHPRA) at http://www.gsu.uts.edu.au/policies/course-work-experience.html

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• Counselling

• Financial Assistance

• Transition and Academic Support Program (TASP): School’s Recommendation Scheme (SRS); Education and Career Support (ECS)

I understand that as a client of the above services:

• that [UTS] SSU staff will only have direct access to my individual file for the service they are working within, however the information contained in each of my service files may be shared between these services as relevant to the service provision provided

• that I’m required to communicate directly with the designated staff of each of the services I’m accessing, to make requests and provide information requested for the provision of my services

• that given these services work collaboratively within the broader Student Services Unit, I give permission for my information to be shared between the staff of these services as relevant to the management of my health, wellbeing, access requirements and academic success.

Signed: Date:

If you have any questions regarding privacy and the Accessibility Service, contact the Manager, Accessibility Service on 9514 1177 or [email protected]. Your rights as a client of the Accessibility Service 1) To be treated with respect and listened to, and to have things explained simply and clearly.

2) To attend appointments with a friend or family member.

3) To provide only as much information you feel comfortable providing, noting that this may limit or prevent the provision of services / reasonable adjustments to you.

4) To accept or reject advice or accommodations at any time, or restrict or revoke any consent provided - noting that this may also limit or prevent the provision of services/reasonable adjustments to you.

5) Registering with Accessibility is not recorded on your Academic Transcript (official record of grades and results).

6) To request a different Accessibility Consultant, however this may not always be possible due to available staff resources. Students should discuss this with their AC in the first instance.

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Your responsibilities as a client of the Accessibility Service 1) To keep your appointments and be on time. To cancel appointments only when absolutely

necessary and let UTS staff know in advance so another student can use that time

2) To be open and honest when responding to questions about your situation. The amount of information you choose to disclose may impact on the capacity of the Accessibility Service to register you and provide support services and/or reasonable adjustments.

3) To assist your Accessibility Consultant by obtaining required supporting information or documents, as soon as possible as evidence to allow accommodations to be put in place.

4) To take responsibility for actions assigned to you as part of any access plan developed with you.

5) To inform your Accessibility Consultant of any changes to your contact details, or changes to your situation that may influence the accommodations put in place for you.

I acknowledge and accept these rights and responsibilities:

Signed: Date:

How to provide this Registration form and supporting documents to the Accessibility Service Send your registration form and supporting documents to:

☐ Email: [email protected]. Or if you have made arrangements, you can email this information directly to your Accessibility Consultant.

☐ Post: UTS Accessibility Service P.O Box 123 Broadway NSW 2007

If you prefer to bring your supporting documents to your appointment, rather than sending them beforehand, please do so. If it is not possible to lodge this information before your first appointment, bring it with you to your appointment. If you are unable to complete this registration form before your first appointment, please arrive early to your appointment to receive a printed registration form to complete, prior to your appointment.

AC Admin use:

☐ Permanent ☐ Temporary ☐ No Documentation/Not Registered ☐ Prospective

AC: