Form for students who require additional support
Please complete this form digitally. It is easier for us to capture your data if you do not fill in the form
by hand.
We welcome applications from students with disabilities or special learning needs. By
1. We welcome your completing this form, you help us to form a clearer picture of your needs, which will
application enable us to see how we could support you, should you be admitted.
As in the case of all other applicants, first of all we consider your academic merits and
whether you comply with the admission criteria for the course that you want to apply
[Link] we will consider what is reasonable and practical for the specific programme to
which you have applied.
2. We protect your
We will respect your privacy and keep your information confidential. However, we have
information to share relevant information with key academic, administrative and support staff
members. They need such information to determine how we might best support you,
should you be admitted for studies at SU.
3. Upload this
Please upload the completed form and all supporting documents (e.g. any copies of
form, along with
medical or psychological proof of your condition and/or disability) when you apply. It is
the supporting very important that we receive all your documents by the closing date for applications.
documents, to We cannot process your application unless we have all the necessary information.
your application
profile
4. Should you need Contact the Disability Unit at the Centre for Student Counselling and Development
assistance or (CSCD) to learn about the kind of support the University offers on +27 (0) 21 808 4707,
information email disability@[Link] or visit [Link]/cscd. You are also welcome to contact
your faculty for more information.
5. When you arrive on We present an orientation session for students with disabilities every year. It takes place
campus at the end of January, as part of the orientation programme for newcomer students.
Remember to apply for assistance with the Disability Unit as soon as possible after
registration. Students may access the welcome information via the Disability
Unit’s web page: [Link]
affairs/cscd/2021-welcoming-info
6. How can we reach When we receive your form, we send it to the faculty or faculties to which you are
you? applying so that they can determine whether they are able to support you. The personal
information you provide here also allows us to locate your application swiftly.
Name and surname
Application ID
Date of birth D D M M Y Y Y Y
Cell number
Email address
Home address
Registrateursafdeling | iCandelo leRejistra | Registrar’s Division
Privaat Sak X1, Private Bag X1, Matieland, 7602
Tel/Ifoni: +27 21 808 4910 | [Link]
A. Your studies
Which programme(s) did you apply for?
Programme 1
(Specify the study field, e.g. BA (Social Work), MSc (Food Science))
Programme 2
Programme 3
B. Particulars of your disability or special learning need
We would like to gain a better understanding of the kind of support that you may need. However, we might not be able to
assist in all the ways that you require, but it might help us with our planning in future.
1. Upon application, you indicated that you have a disability or special learning need. Please describe it briefly.
2. What kind of support did you receive at secondary school level or at an institution of higher learning?
3. Please inform us if you have a mobility disability and/or make use of a wheelchair. If you use a wheelchair, please describe
the type of wheelchair that you use. What support or assistance would you need in order to participate in activities like
fieldwork, community interaction, or laboratory work?
4. Assistance to move about on campus
I use a guide dog or service dog, or I intend to apply for a dog.
I require assistance to orient myself on campus (e.g. where pedestrian and wheelchair friendly routes are).
What additional assistance would you require to be mobile on campus (e.g. roadways, lifts and handrails)?
2
5. Assistance in the classroom and other learning environments
I cannot do laboratory work without assistance (e.g. work involving a microscope, dissections or experiments).
I would require a sign language interpreter, if one were available.
6. My study material must be converted into:
Electronic format (PDF or MS Word) Braille Increased font size
What additional assistance would you require during lectures or practicals (e.g. that the lecturer use a microphone in a
large lecturing hall
7. Assistance during tests, examinations and other forms of assessments
I need extended writing time.
I need an alternative way to be assessed – I would like to consult about this.
a) My study material must be converted into:
Electronic format (PDF or MS Word)
Braille
Increased font size (please specify) pt
Preferred paper size A4 A3
b) I answer question papers as follows:
I write down the answers by hand With the assistance of a scribe
With the assistance of a reader With the assistance of a sign language interpreter
With the assistance of a computer (but without specialised support software)
With the assistance of a computer as well as support software: JAWS NVDA ZoomText
WYNN Dragon Dictate Other
8. Assistance at the residence
If you were placed in a University residence, what kind of assistance would you require? (e.g. adapted bathroom facilities,
gender neutral bathroom areas or accessible routes)
9. Financial Assistance
Are you receiving financial support for your studies and personal needs?
YES NO
10. Indicate and elaborate on any other special needs or assistance that may be required: