Disability/Medical Condition Request For Assistance Form

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Student Information

Please enter your information
Please use your email address issued by the University of Notre Dame Australia

Admissions and Academic Information

Are you a prospective student or enquiring on behalf of a prospective student?
What campus are you attending?
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Accessibility Specific Information

My diagnosis/health condition falls into the following categoryRequired
Upload supporting document(s)

If you do not have any current supporting documentation, please select your campus to download a copy of our Treating Health Professional Report. Please complete and bring this to your first appointment. 

Treating Health Professional Report (Fremantle)

Treating Health Professional Report (Sydney)

Preferred method of contact
Please indicate which day/s you prefer appointments to be scheduled
We will do our best to accommodate your preferred appointment days, but it may not always be possible.

Please specify morning or afternoon and/or specific times for your appointment.

Consent for ServicesRequired

I have requested advice/assistance from the University on Access and Inclusion services, equipment and facilities.

I understand that as a person with a disability I give my consent for the release of information relating to my disability and/or medical condition, to the relevant University staff as necessary to arrange approved services, equipment or adjustments to learning and/or assessment conditions.

I understand that the purpose of the assessment interview is to determine my needs.

The University of Notre Dame Australia cannot guarantee any or all of the services I have requested. I am aware that The University of Notre Dame Australia will advise me of the outcome of the assessment within fifteen (15) working days of completion of the assessment and/or submission of all required documentation.

The University provides information to the Australian government Department of Education, as part of its obligations under the Higher Education Support Act (2003). This may also assist in the planning and funding of government programs and services for students with disability. I understand that the University will provide information to the Department of Education that;

I have a disability, impairment or long-term medical condition that is defined in the category below: (please indicate below – you can choose more than one category if relevant)

I understand that it is my responsibility to distribute my Learning Access Plan (LAP) to relevant Notre Dame staff, and to do so in a timely manner to ensure adjustments are implemented. 

Privacy Statement

The information provided in this form will be used for the purposes of, and in relation to, your potential enrolment at The University of Notre Dame Australia. Where the privacy principles apply, the University restricts access to those staff members who may need the information in the carrying out of their responsibilities in the academic and/or personal interests of the student. The University does not provide, by commercial arrangement or otherwise, the personal information of students or other stakeholders except in the following cases: a) when authorised in writing to do so, and b) where required or authorised by law to government and regulatory authorities; credit reporting and fraud-checking agencies; to your authorised representatives (e.g. legal representatives).