Please fill out front and back of this form * signature - Eleanor 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in your personal information. Enter your Family Name, Given Name, Nationality, Course Applied for, Email Address, and Mobile Phone in the designated fields.
3. Next, provide details about your Parent/Guardian including their Name, Contact Number, Email, and Address.
4. In the Declaration section, indicate any diagnosed conditions by ticking the appropriate boxes. If applicable, specify other conditions in the provided space.
5. Answer whether you will require accessibility services during your studies by selecting 'Yes' or 'No'. If yes, tick any specific requests that apply.
6. Indicate if you are currently receiving treatment for any condition in the designated area.
7. Finally, sign and date the form at the bottom. Ensure both Student and Parent/Guardian signatures are included.

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