All information given to Student Support Services is treated confidentially. Student Status*I am currently studying in CDCFEI will be starting a course in SeptemberCourse*Animation FoundationAnimation HND 1Animation HND 2Architectural Design & Technology FoundationArt & Design Portfolio PreparationBarberingBarista Skills (BTEI)BiotechnologyBuilding ConstructionCafé& Deli Skills- BTEICertificate in Business 1Certificate in Business 2Community Development 1- VTOSCommunity Development 2- VTOSComputer Networking Technologies Yr 1Computer Networking Technologies Yr 2Computer Science 1Computer Science 2Craft Production- VTOS level 5Craft Production- VTOS level 6Creative Writing for Digital MediaDigital DesignEarly Childhood Care & Education BTEI- Year 1Early Childhood Care & Education BTEI- Year 2Early Childhood Care & Education L5Early Childhood Care and Education L6Engineering TechnologyEnglish for Speakers of Other Language ESOL-VTOSEnvironmental Monitoring and SustainabilityEntrepreneurship in Creative Industries- VTOSFashion Design 1Fashion Design 2Film Production HND 2Film Production HND1Floristry-VTOSIT Technician (Pre-Apprenticeship) 1General Education- VTOSGraphic Design 1 - Visual CommunicationsGraphic Design 2- Visual CommunicationsHairdressing Pre ApprenticeshipHealth and SafetyHealth and Wellbeing Programme-BTEIHealth Science -Pre-NursingHealth Service Skills - VTOSHealth Service Skills- BTEI Year 1Health Service Skills- BTEI Year 2Horticulture-VTOSInterior Design 1Interior Design 2Journalism HND 1Journalism HND 2Media Production Foundation (Media 1)Media Production HND 1 (Media 2)Media Production HND 2 (Media 3)Mural Urban Art-BTEIMedical Laboratory Science HND 2National Hairdressing ApprenticeshipNeurodiversity Access to IT ApprenticeshipNutrition & Lifestyle CoachingOccupational Therapy AssistantOutdoor Adventure Management HND 1 (Shackleton 2)Outdoor Adventure Management HND 2 (Shackleton 3)Outdoor Recreation (Shackleton 1)Performing Arts HND 1Performing Arts HND 2Photography Level 6Physiotherapy Assistant (Health Service Skills)Pottery for Beginners-BTEIPre-Primary School TeachingPre- University Science- DCUPre-University Science-QQIPre-University Sports SciencePreliminary EngineeringSocial Media InfluencerSocial Care Level 5Social Care Level 6Speech and Language Therapy AssistantTour GuidingTourism with Marketing 1Tourism with Marketing 2Traineeship in Manufacturing, Supply Chain & Customer Service LogisticsYouth Activities WorkerName* First Last Date of Birth* Date Format: MM slash DD slash YYYY GenderMaleFemalePrefer Not To DiscloseAddress* Street Address City Mobile Phone Number 1*Phone Number 2Email Address* NationalityDisability Information*Tick the boxes below to indicate the disability. Attention Deficit Disorder ADD, Attention Deficit Hyperactivity Disorder ADHD Autistic Spectrum Disorder (ASD) (including Asperger’s syndrome) Blind/Vision Impaired Deaf/Hard of Hearing Dyscalculia & Dysgraphia Dyslexia General Learning Difficulty/Acquired Brain Injury Mental Health Condition Neurological Condition Physical/mobility Speech, Language and Communication Disorder Significant Ongoing Illness (Epilepsy, Diabetes, Other) Developmental Co-ordination Disorder (Dyspraxia) Difficulty with IT and computer Skills Difficulty with Reading and Writing Difficulty with Maths Other (please give details) Other*Please give details of your disabilityImpact-Please explain in your own words how the disability/difficulty you have ticked above affects how you learn.*I agree to share this impact section with my tutors* Yes No Record assistance you availed of in your previous school/ education experience.* SNA/ESW Full time SNA/ESW Part-time or shared Resource hours Technology Transport Evidence of disability:The College requires documentation from an acceptable professional source that verifies your disability. Please indicate the documentation you can provide to the college. Audiologist/ ENT report Consultant Letter from the School for the Deaf or Blind Neurologist Occupational Therapist Ophthalmic Surgeon Psychiatrist Psychologist Speech and Language therapist No Documentation Available Other For Dyslexia Only For Dyslexia Only Educational Psychologist report* Yes No What school were you in when your last report what done?* Primary School Secondary School All disclosures to the Learner and Disability Support Services in the college will be treated confidentially. Services are provided by National Learning Network. Information on this form will be shared with National Learning Network.