Applicant's Disability/Condition
Applicant's Disability/Condition:
Are there any other co-existing conditions or relevant difficulties?
The information provided by the applicant in the EIS Checklist below should guide you to the relevant EIS Indicators. Not all Indicators are relevant to all applicants. It is important to note that all Indicators do not need to be completed to meet the DARE educational impact criteria.
EIS Checklist
Please ask the applicant: Has your educational experience been affected by your disability/condition in any of the following ways? Record their response to each of the following:
I needed and received supports in school or exam accommodations. Yes ☐ No ☐
My school or class attendance has been disrupted. Yes ☐ No ☐
It has impacted on my overall experience of school. Yes ☐ No ☐
It has impacted on my school exam results and learning. Yes ☐ No ☐
I have experienced other educational impact not listed above. Yes ☐ No ☐
My literacy and/or numeracy abilities have been impacted. Yes ☐ No ☐
1.1 Has the applicant received additional support in school due to the impact of their disability? Yes ☐ No ☐
Indicator 1: Intervention and Support
If yes, please select years that support(s) was received:
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