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Reasonable Adjustment Requests
Personal Details
Full Name
*
Address
*
Date of Birth
*
+
Gender
*
Male
Female
Non-Binary
Trans
Prefer not to say
Telephone Number
*
Email Address
*
What is your current coaching qualification level?
*
None
Level 1
Level 2
Level 3
Level 4
Do you have any long-term health conditions, impairments or illnesses affecting any of the following areas that have a substantial effect on your ability to do normal daily activities? Long-term means that they have lasted, or are expected to last, 12 months or more. Please select all that apply
*
Breathing or Stamina
Chronic health condition (for example, but not limited to, diabetes, coronary heart disease, stroke, epilepsy and hypertension)
Dexterity (for example lifting and carrying objects, using a keyboard)
Hearing (for example deafness or partial hearing)
Learning or understanding or concentrating
Long term pain
Memory
Mental Health
Vision (for example blindness or partial sight)
Physical Impairment (for example wheelchair user or amputee)
Mobility (for example walking short distances or climbing stairs)
Social or behavioural (for example, but not limited to, associated with autism, attention deficit disorder or Asperger's syndrome)
Other (please specify)
Other (please specify)
Please outline any reasonable adjustments and/or special considerations that you may require in order to enhance your learning on our course while also helping our tutor workforce to create the most inclusive content possible
*
If you are unsure of any details to be completed you can message the LTA via the
Contact Us
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