Student Services

Disability Support Services Online Registration

Personal Details
Student ID *
(If prospective, please type "PROSP" in the box)
First Name*
Last Name*
Address:*
Suburb / Town*
State*
Postcode*
Country (if not Australia)
Home Phone
Mobile Phone
Email
Course Details
Are you studying in	TAFE Higher Education (University)
Course commenced date
Expected completion date
Course Name
Course Status	Part -Time Full - Time Off Campus
Disability Details
Disability Type (tick all that may apply)
Other Disability (if not listed above)
Services requested (if known)*
To be eligible to receive services from Disability Support Services, students must be able to provide relevant documentation from a qualified professional in the particular field of disability or health. After you have submitted this form a Disability Liaison Officer will be in contact with you to arrange submission of this documentation.
For further details about eligibility please visit http://www.swinburne.edu.au/stuserv/disability/eligibility.html#documentation
Further Information
How did you find out about the Disability Support Service?	Brochure Teacher / Lecturer Other staff Saw the office Friend VTAC Swinburne website Secondary college Open Day Orientation Letter from the Disability Support Service Other
If you selected 'other', please elaborate
The Disability Support Service will contact you to discuss support options. Please indicate your preferred contact method	Home phone Mobile phone Email Other
If you selected 'other', please elaborate
Any further information you would like to provide*

Fields marked with an * are mandatory.

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