Disability Support Registration Form

We value your privacy and we have a strong commitment to confidentiality.

The information you provide on this form will be kept within Disability Support. It will assist us to provide a prompt and personalised response to help ensure the right support is in place for your studies.

Information about the nature of your disability or medical condition will not be disclosed and will not appear on your academic records.

For more information please visit the confidentiality page.

Please complete all sections of the registration form.

NB: You will need to upload supporting medical documentation (Verification and Impact Statement or Psychological Assessment or medical reports) at the end of the registration form.

If you require assistance to complete this online registration form, please phone Disability Support on 08 8313 5962.

Personal details

Please indicate if you are a current or prospective student

(Date format: DD/MM/YYYY)

Are you:

Contact information

Program information

Please indicate whether you are studying part time or full time

Disability/medical information

Please be assured that the information you provide on this form is only available to Disability Support.
Did you have special provisions in Year 12?
Please upload any documentation of Year 12 provisions.
One file only.
20 MB limit.
Allowed types: gif jpg png bmp eps tif pict psd txt rtf html odf pdf doc docx ppt pptx xls xlsx xml avi mov mp3 ogg wav bz2 dmg gz jar rar sit svg tar zip.
Have you previously studied at a tertiary institution?
One file only.
20 MB limit.
Allowed types: gif jpg png bmp eps tif pict psd txt rtf html odf pdf doc docx ppt pptx xls xlsx xml avi mov mp3 ogg wav bz2 dmg gz jar rar sit svg tar zip.

Please upload documentation of any special provisions or Access Plan.

Please indicate the services you are seeking assistance with:

Medical information & documentation

Please note: 

  • Documents must be scanned and not photographed. Scanning facilities are available at Hub Central 
  • The maximum total file size for all of the documents attachments included in this form is 20MB, if the total is over that amount the form will not submit.

For further information regarding scanning facilities, please visit Ask Adelaide.

Please upload a scanned copy of all relevant information including;

One file only.
20 MB limit.
Allowed types: gif jpg png bmp eps tif pict psd txt rtf html odf pdf doc docx ppt pptx xls xlsx xml avi mov mp3 ogg wav bz2 dmg gz jar rar sit svg tar zip.
One file only.
20 MB limit.
Allowed types: gif jpg png bmp eps tif pict psd txt rtf html odf pdf doc docx ppt pptx xls xlsx xml avi mov mp3 ogg wav bz2 dmg gz jar rar sit svg tar zip.
One file only.
20 MB limit.
Allowed types: gif jpg png bmp eps tif pict psd txt rtf html odf pdf doc docx ppt pptx xls xlsx xml avi mov mp3 ogg wav bz2 dmg gz jar rar sit svg tar zip.
One file only.
20 MB limit.
Allowed types: gif jpg png bmp eps tif pict psd txt rtf html odf pdf doc docx ppt pptx xls xlsx xml avi mov mp3 ogg wav bz2 dmg gz jar rar sit svg tar zip.
One file only.
20 MB limit.
Allowed types: gif jpg png bmp eps tif pict psd txt rtf html odf pdf doc docx ppt pptx xls xlsx xml avi mov mp3 ogg wav bz2 dmg gz jar rar sit svg tar zip.
If you are unable to provide your relevant documents, please outline the reason below:
Additional information
Please include any other relevant information in the box below: