Equality and Diversity Centre

Disability Support Services Registration form

First name Required
Last name Required
Are you a currently enrolled student? Required	Yes No
If you chose Yes, please provide Student number
Student email address This must be your @students.latrobe.edu.au address
Mobile number
Home phone number
Course
Are you an International student? Required	Yes No
Faculty
Campus
Which category relates to your condition?
Is your condition Required	Permanent Temporary
Please provide brief details about your condition. Required
Please describe how your condition impacts on your study. Required
Please attach evidence of your disability or condition from a relevant practitioner.

Please attach evidence of your disability or condition from a relevant practitioner. (Documentary Evidence Guidelines (PDF 133KB) (DOC 215KB) or complete the Health practitioner's statement (PDF 156KB) (DOC 96KB)).

NB: If unable to provide evidence now, please bring to your first appointment or discuss with a Disability Advisor at your first meeting.

Equality and Diversity Centre

Disability Support Services Registration form

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