Please fill in all fields marked with an *

Student Profile:

* Were there concerns about the your early development (e.g. walking, talking etc.)? If there were, please give details:

* Are there any medical condition/s that may be affecting your academic progress?

Has you been assessed by any of the following?

* What are your main academic strengths?

* What are your main academic weaknesses?

* What are your main interests and hobbies?

* What are the main academic challenges facing you in college?

* What measures/resources could be put in place to help you overcome these challenges?

Educational Profile

* Did you receive learning support or resource hours in primary school? YesNo

If you did, please answer the following:

Learning Support

Resource teaching support

Did you receive learning support/ resource teaching hours in post-primary school? If you did, please answer the following:

Learning Support

Resource teaching support

* Did you receive any reasonable accommodations (RACE- reader, scribe, waiver in spelling and grammar etc.) when doing the Junior or Leaving Certificate examinations? YesNo

* Are you receiving any support from the Disability Services in the college? YesNo

Consent

I consent to a psychological appraisal by Edward Joyce, Psychologist. Note: The information contained in this application form will be used as part of the evaluation process, and will be seen only by Edward Joyce, Psychologist.

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