UAC APPLICATION NUMBER: 132545319

MISS AIDA ABOUZEID

9 BRUCE ST KINGSFORD NSW

P01A: PERSONAL ILLNESS/DISABILITY

WHAT YOU NEED TO DO
1. Complete the applicant statement of this form.
2. Arrange for the educational impact statement to be completed.
3. Arrange for the medical impact statement to be completed.
4. Collect all relevant documents outlined under ‘Documentation required’.
5. Upload this completed form and documents to your EAS application, as soon as possible.

– If you need more room to write your statement, use a separate sheet of paper.
– UAC will not contact you in relation to missing or insufficient P01A documents.
– Your application can’t be assessed until your supporting documents have been uploaded.
– Any hard copies of documents received by UAC will be scanned then destroyed.

ELIGIBILITY CRITERIA
For a period of at least six months during Year 11 and/or 12 or equivalent you experienced:

– a severe and long-term or a severe and recurrent medical/psychiatric condition or disability, or

– a learning, sensory, physical, psychological or other disability/disorder.

P01A consideration will not necessarily be given to applicants who have not sought and utilised recommended options (made by a registered
health professional) for their condition, disability, illness or disorder, where relevant.

You're not eligible if:

– you become ill or suffer a condition that affects your examination performance only
– you have suffered a series of minor illnesses,
– you have an ongoing minor medical condition stabilised by medication, or
– you are only receiving ongoing rehabilitation or treatment, where the commitment is less than two hours per week.

EDUCATIONAL IMPACT STATEMENT: REQUIRED FOR P01A

The Educational Impact Statement (EIS) must be completed by someone who can comment on the circumstances outlined in your applicant
statement and must not be altered, or added to, by you in any way.

If you’re a current Year 12 student: the EIS must be completed by your school/college principal, counsellor, year adviser or careers adviser. If
you’re unable to have your school complete the EIS, it must be completed by a responsible person. You must also attach an explanation as to why
your school can’t complete the EIS.

If you’re a non-Year 12 student: the EIS must be completed and signed by a responsible person.

A responsible person is a doctor, lawyer, accountant, social worker, counsellor, religious or community leader who is familiar with your
circumstances and who can provide information regarding your disadvantage and its effect on your ability to study. The person must not be a
family member or friend.

DOCUMENTATION REQUIRED
– Applicant Statement
– Educational impact statement
– Medical impact statement
– Medical certificates/reports
– Letter from your school that provides details of any absences from school and/or disruption to your learning. The document must be on the
school letterhead and must be signed by the principal or another senior person at the school.
– Any other relevant information; for example, the NSW Education Standards Authority letter approving your application for Disability
provisions in your HSC

MEDICAL IMPACT STATEMENT: REQUIRED FOR P01A

– You must arrange for all parts of the Medical Impact Statement to be completed by a registered health professional who is familiar with your
condition.
– The person must not be related to you.
– Examples of a registered health professional are a medical practitioner, psychologist or medical specialist.
– The Educational Impact Statement and Medical Impact Statement must not be completed by the same person.
UAC APPLICATION NUMBER: 132545319
MISS AIDA ABOUZEID
9 BRUCE ST KINGSFORD NSW

P01A: PERSONAL ILLNESS/DISABILITY

ADDITIONAL DOCUMENTATION REQUIRED - LEARNING DISABILITY (LD) ONLY

– If you applied for and were granted disability provisions by the NSW Education Standards Authority (NESA) (or interstate
equivalent), provide NESA’s disability provisions decision notification along with any documentation submitted to NESA.
– If you did not apply for disability provisions, you must explain why in the Applicant Statement, and attach evidence of a clinical
assessment conducted by a qualified professional such as an educational psychologist, neuro-psychologist or learning disability
specialist using recognised valid, reliable and standardised tests. These must have been undertaken within the last three years.

APPLICANT STATEMENT

1. What is your medical condition/disability?

2. Describe the nature and impact of your medical condition/disability.

3. Provide details of the period you've had your medical condition/disability and the school years involved.

4. Provide details of any treatment you've received, or are receiving, for your medical condition/disability.

5. Describe the effects of your condition/disability on your educational performance.

6. If you have any other information specific to this claim that may inform our assessment, please provide details.
UAC APPLICATION NUMBER: 132545319
MISS AIDA ABOUZEID
9 BRUCE ST KINGSFORD NSW

P01A: PERSONAL ILLNESS/DISABILITY

EDUCATIONAL IMPACT STATEMENT
To be completed by the school or a responsible person.

1. Have you identified an impact of the circumstances described by the applicant, on their educational performance?

Yes No

2. If yes, indicate the impact of the applicant’s circumstances on their educational performance by ticking ( ) the appropriate box.

Extreme Considerable Moderate Slight

3. What was the duration of the educational disadvantage?

Years Months

Put a dash (-) in any unused boxes

4. Please provide details of the educational impact.

Details of person completing the Educational Impact Statement

Name (print) Position/occupation

Name of organisation (if applicable)
Address State Postcode
Daytime telephone Alternative telephone
Signature Date
UAC APPLICATION NUMBER: 132545319
MISS AIDA ABOUZEID
9 BRUCE ST KINGSFORD NSW

P01A: PERSONAL ILLNESS/DISABILITY

MEDICAL IMPACT STATEMENT
To be completed by registered health professional

1. List the condition/disability affecting the applicant.

2. How long has the applicant been affected by the long-term medical condition/disability?

Less than 6 months 6-11 months 1-2 years More than 2 years

3. How many times have you seen the applicant during the past two years specifically about the medical condition/disability.

4. Describe the nature and duration of any treatment for the medical condition/disability.

5. Describe the ways in which the applicant's long-term medical condition/disability and/or treatment has affected their educational
performance.

6. Indicate the impact of the applicant's circumstances on their educational performance by ticking ( ) the appropriate box.

Not at all Slight Moderate Considerable A great deal

Details of registered health professional completing the Medical Impact Statement

Name (print)
Position/occupation Reg/Provider No.
Name of organisation (if applicable)
Telephone Fax
Signature Date