Assessment Application Form

If you have difficulty completing this application form, please contact the Assessment Service for assistance.

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    Applicant Information


    Section A - About You

    Would you please complete this application form with as much detail as possible. The information you give will help us to plan for your assessment.

    If you know the name of your medical condition (e.g. cerebral palsy), please write this here. If you have a non-specific medical condition please give as much information as you can, (e.g. back problems or problems with concentration).

    Please give as much information as possible. For example, are your limbs affected by restricted movement or lack of strength? Do you easily get tired of have problems with coordination, etc?

    Please give the date if known.

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