HiddenDate of assessment* DD slash MM slash YYYY PDE/Coach/Tutor Name* First Last Learner DetailsFull name (as per ILR)* First Last ULN - Unique Learner Number What is the nature of the long term disability, health problem or any learning difficulties? (if applicable)Ask the learner this question and select the best fit to their response from the list. Multiple selections are possible. Emotional/behavioural difficulties Social and emotional difficulties Moderate learning difficulty Severe learning difficulty Dyslexia Dyscalculia Other specific learning difficulty (e.g. Dyspraxia) Autism spectrum disorder Asperger's Syndrome Health problem Physical disability (including sensory) Other Other* Do you have any documents, support plans or assessments that you would be happy to share; e.g. formal diagnosis, assessment or support plan from previous education?* Yes No Previous education – such as school or college. These may be referred to as: Special Educational Needs (SEN) statement; a Learning Difficulty Assessment (LDA); or an Education, Health and Care Plan (EHCP) or simply a ‘statement’ Type of document/s to be provided* What support have you received in the past during teaching or support sessions? e.g. in school or college Access to learner materials prior to the teaching session Timed rest breaks Written questions to back up verbal Contextualising English and maths by making it workplace-based or specific Time allowance for processing verbal questions or extended task timings Additional one-to-one sessions Adaptive or assistive technology or aid (e.g. text to speech software) Different coloured ink, reading pens or paper Bilingual dictionaries for translation Overlays or visual aids Increased font size/specific font style and/or colour Access to staff trained in working with those with learning support needs Support of a reader and/or scribe and/or prompter Support for communications and sensory needs Training for employers regarding Additional Learning Needs (e.g. for work placements) Details of Support NeedsEnough details to identify the reasonable adjustment to teaching and/or learning delivery (non-equipment)Do you require any equipment or materials to help you access your learning?Include enough detail for us to identify the resources required e.g. assistive software (name); hardware (spec/description); coloured overlays (colour, type) Have you received support in the past during exams or assessments? Yes No If Yes is recorded, the Additional Support Team will pick this up. Reasonable adjustments to assessments; e.g. examinations. Sometimes called Access Arrangements. Types of reasonable adjustments might include: extra time to complete an exam a separate room ‘stop the clock’ rest breaks alternative exam format (paper, colour, font size etc. a scribe and/or reader use of a computer/laptop What support have you received in the past during exams or assessments?*What has the learner received in the past? e.g. at school or college Reasons for requesting alternative exam arrangements (reasonable adjustments) might include: a Learning Difficulty such as dyslexia or dyscalculia an Autism Spectrum Disorder (ASD) such as Asperger’s Syndrome Physical Disabilities chronic or acute ill-health mental Health issues recommendations made in a learner’s EHCP, LDA or SEN statement Types of reasonable adjustments might include: extra time to complete an exam a separate room ‘stop the clock’ rest breaks alternative exam format (paper, colour, font size etc.) a scribe and/or reader use of a computer/laptop Do you need any support or advice to help keep you safe or support your wellbeing?* Yes No What support or advice do you need to help keep you safe or support your wellbeing?*Support for those with social and safeguarding support needs may include: Additional one-to-one support from tutors, assessors, additional support staff, HR teams, and line managers to provide coaching and reassurance Mentoring and buddying support. Information advice and guidance to enable learners to access external support services. Signposting to other sources of practical support. Providing advice and guidance on managing money issues. Note that any safeguarding disclosure should be followed up immediately with the Safeguarding Team following Corndel's Safeguarding and Prevent Policy. Advise the learner that you will need to take advice from the team. Do you need any additional support in the workplace?* Yes No What additional support will you need in the workplace?*Support may include: Providing support on understanding employability skills and behaviours. Wheelchair access. Support associated with COVID-19 (e.g. reassurance, risk assessments). Mentoring and/or buddying support. Summary of adjustments to teaching and learning agreed:*Once agreed, these adjustments should be copied to the ILP, put into action needed from and/or planned for. Take advice if needed from the Additional Support Team.