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AccessAbility Hub Registration Form

Before you complete this registration make sure you have evidence of your disability or condition from a relevant practitioner. Please scan these documents so you can attach/upload them using the facility below. If you don't have a scanned copy of your Health Practitioner Statement you can take a photo of the documents with your phone and upload them below, or email these documents to Access.ability@latrobe.edu.au

For further information on student information and privacy see https://www.latrobe.edu.au/privacy/student-information

If you experience any issues with the accessibility of this form please email Access.Ability@latrobe.edu.au and a paper version will be provided

Registration Form – Confidential

For students who are living with a mental health condition, ongoing medical condition or disability (this may include physical, neurological, intellectual, sensory, acquired brain injury, or specific learning difficulty) or you are a carer for someone living with a mental health condition, ongoing medical condition (including a terminal or chronic illness), disability or is frail and aged.

Please note: Fields marked with an asterisk (*) are required.

Given name *

Family name *

Preferred pronoun

She/her
He/him
They/them

Please provide your student number

Student email address * Please use your @students.latrobe.edu.au email address

Preferred Contact Number

Course of Study

Campus *

Please specify

Are you of refugee background *

Year of arrival

Country of origin

Languages spoken

Visa category Please attach a copy of your Visa or relevant Centrelink documents at the end of this form

Care Leavers - La Trobe offers a range of supports to students who have spent time in out-of-home care. Have you spent time in out-of-home care (including foster care, residential care, kinship care, and/or being a ward of the State)? *

Do you consent to the AccessAbility Hub informing the Support Coordinator, Transition and Success that you have registered?

Would you like the AccessAbility Hub to inform any of the below services that you have registered with the AccessAbility Hub and may require additional assistance?

Accommodation Services

Indigenous Student Services *

International Student Services *

Are you caring for a person living with a mental health condition, ongoing medical condition (including a terminal or chronic illness), disability or is frail and aged? *

Are your responsibilities as a carer temporary or permanent? Please attach a copy of your carer card AND/OR a carer Health Practitioner Statement at the end of this form

Temporary
Ongoing

How do your responsibilities as a carer impact on your studies?

Are you a student living with a mental health condition, ongoing medical condition or disability (this may include physical, neurological, intellectual, sensory, acquired brain injury, or specific learning difficulty)? *

Select the categories that relates to your condition:

Acquired brain injury (including disabilities resulting from head injury or stroke)
Autism/Asperger’s
Deaf/Hard of Hearing
Medical Condition
Specific Learning Difficulty
Mental Health Condition
Neurological
Physical/Mobility
Low Vision/Blind
Intellectual
Other

Is your condition

Temporary
Ongoing

Please provide brief details regarding the impact of your mental health condition, ongoing medical condition or disability (this may include physical, neurological, intellectual, sensory, acquired brain injury, or specific learning difficulty) on your studies?

If you have an NDIS plan, would you like information on how your NDIS plan may support your university experience? *

Please provide a copy of your Health Practitioner Statement AND/OR provide relevant supporting documentation* * *Supporting documentation could be a comprehensive letter/report from a relevant health practitioner. Important: for Specific Learning Disability (e.g. Dyslexia) and Autism Spectrum Disorder, please provide relevant documentation that includes tests designed to assess and diagnose such conditions for an adult (aged 16 years or older) where available.If you do not currently have evidence of your disability/condition, please attach a copy of your student card and we will be in touch to discuss further

Additional attachment (NB: max file size 8MB. DOC, PDF, JPG or PNG file types ONLY)

Disclosing your condition or disability

The AccessAbility Hub provides a range of services with Commonwealth funding that is allocated according to the number of students that declare to the University that they have a mental health condition, ongoing medical condition or disability. Disclosing that you have a mental health condition, ongoing medical condition or disability when confirming your enrolment details via StudentOnLine helps us develop accurate statistics and access valuable funding.

I give permission for the AccessAbility Hub to amend the details of my enrolment form to confirm that I have a disability solely for the purposes of accessing funding from the Commonwealth Government. NB: Only de-identified information is reported to the Commonwealth Department of Education, Skills and Employment and the Higher Education Information Management System.

I agree *

Privacy & Confidentiality Information

In accordance with Privacy Laws and Principles the AccessAbility Hub collects personal information to establish your support needs. Refer to Privacy Collection Notice for more details. All information held by the AccessAbility Hub remains confidential unless disclosure is required by law.

When arranging your reasonable adjustments, relevant university staff members are informed of the functional implications of your condition and the recommended adjustments.

Consent & Disclosure Agreement

By signing this form, I give permission for the AccessAbility Hub to share relevant information with the following people/organisations:
- Relevant University staff; including subject coordinators and/or the examinations team.
- Health Practitioners and other relevant professionals for the purpose of clarifying my need for services or facilities, as per documentary evidence I have provided and only where there is a need to do so.
- Agencies/individuals providing services (e.g. readers/scribes/alternative formats) with my name, student number, contact details and services to be provided, where applicable.

I have read and agree to the confidentiality statement above *

The AccessAbility Hub will send occasional emails regarding information/opportunities that may be of interest to students registered with the AcessAbility Hub.
Please contact the AccessAbility team at access.ability@latrobe.edu.au if you have any concerns or would like to discuss anything further prior to completing your submission.

Additional Comments:

Validation

Confidentiality

All information provided by applicants will be treated as confidential. At La Trobe University, we respect the privacy of your personal information. We collect personal information in your application to determine your eligibility for disability support services. In accordance with privacy laws, personal information about you contained in your application will not be used for any other purpose or disclosed to any person who is not part of the La Trobe assessment process, without your permission. You may have the right to access personal information we hold about you, subject to any exceptions in relevant laws, by contacting your campuses Equity and Diversity team. The La Trobe University privacy policy can be viewed at: www.latrobe.edu.au/privacy/