Additional Learning Support Questionnaire

PERSONAL DETAILS (Student)
Title: (please select)*
- Mr
- Miss
- Ms
- Mrs
- Other
Please state your title:
Name*
First name Surname
Email
Date of Birth*
DD slash MM slash YYYY
Please confirm which year you wish to enrol by choosing from the drop down list below.*
Do you have a Learning Difference and/or Disability and/or Mobility/Medical Condition?*
- Yes
- No
Learning Difference and/or Disability and/or Mobility/Medical Condition*
Please click ‘traits of’ if you are on a pathway to a diagnosis, or do not have a formal diagnosis.
- Autism (diagnosed)
- Attention Deficit Hyperactivity Disorder (diagnosed)
- Dyslexia (diagnosed)
- Dyscalculia (diagnosed)
- Dyspraxia (diagnosed)
- Hearing Impairment
- Social and Emotional Difficulties
- Speech, Language and Communication Difficulties
- Autistic Traits
- Attention Deficit Hyperactivity Disorder Traits
- Dyslexic Traits
- Dyscalculic Traits
- Visual Impairment
- Disability affecting mobility
- Mental Health Difficulties
- Other Physical Difficulties or Medical Conditions (e.g. epilepsy, allergies, asthma)
Please provide us with further details*
Do you have written evidence of the above?*
This could include (but is not limited to) medical letters, psychologist reports, or those from other support agencies such as CAMHS, information from school such as confirmation of exam arrangements, a copy of ‘Form 8’ or the school’s Centre File Note – speak to the SENCO at school if you are unsure. If so, please forward a copy to als@brooklands.ac.uk or alternatively upload below.
- Yes
- No
- Don’t Know
Upload your written evidence (Optional)
Drop files here or

Max. file size: 512 MB, Max. files: 5.
Maximum 5 files
Do you have an Education, Health and Care Plan (EHCP)?*
Please be advised that you will not be able to complete your enrolment until we have received your EHCP from your Local Authority Case Officer.
- Yes
- No
Are you entitled to Exam Access Arrangements?*
- Yes
- No
Please tick all that apply*
Please select any Exam Access Arrangements you have previously had from the list below:
- Reader
- Scribe
- Laptop/Word Processor (WP)
- 25% Extra Time
- 50% Extra Time
- Smaller room (alongside other students)
- Individual Room
- Rest Breaks
- Prompt
- Reader Pen
- Coloured Overlays
- Modified paper (e.g: enlarged text, coloured paper)
Consent*
Please read and tick below to confirm you have understood the following:
I confirm the information I have detailed above is accurate and it is my responsibility to provide supporting evidence to receive the correct access arrangements for my exams by the 19th December 2025 (or 4th October 2025 for November GCSE resits/January BTEC exams).

If you do not have the appropriate evidence, please email ALS@Brooklands.ac.uk as soon as possible to make alternative arrangements.
Please tell us more about your additional learning needs and how we can support you
Communication and Interaction
Do you have any difficulties in communicating with others, understanding instructions, or expressing your ideas/opinions? If so, please describe below.
What I find difficult How you can help me
Learning
Do you have any difficulties with coursework or exams? Do you have any difficulties staying focused and completing work in lessons? Do you experience challenges in Maths or English? If so, please describe below.
What I find difficult How you can help me
Social, Emotional and Mental Health
Do you experience any challenges with your mental health that impact upon your learning? Do you have any difficulties around other people or in your relationships/friendships? If so, please describe below.
What I find difficult How you can help me
Sensory & Physical
Do you have any sensory sensitivities or a physical disability that impacts upon your learning? If so, please describe below.
What I find difficult How you can help me
Do you have any other difficulties currently that you have not mentioned above? Please provide details
If we need to speak to you further about the information which you have provided, we will contact you by phone or email.
Consent*
I give consent to the processing of my data
I give consent to the processing of my data
I give consent to the processing of my data by Brooklands College and any other organisation which has a statutory right to receive any of it in accordance of the Data Protection Act 2018.
Any information disclosed will be treated confidentially. However, in order to provide the best support for you this information may need to be shared with other people within the college e.g. course tutors and the exams department.
By submitting this form to Additional Learning Support staff, I give permission for information concerning my support needs to be shared with relevant departments.
I declare to the best of my knowledge that the information I have given is a true and correct record.
Signature*
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What I find difficult	How you can help me

What I find difficult	How you can help me

What I find difficult	How you can help me

What I find difficult	How you can help me

Additional Learning Support

PERSONAL DETAILS (Student)

Please tell us more about your additional learning needs and how we can support you

If we need to speak to you further about the information which you have provided, we will contact you by phone or email.