Special Consideration application form

This form should be completed by candidates wishing to apply for special considerations for training or qualification-related purposes in cases where the learner is unable to submit the application to the Approved Training Centre/Provider Co-ordinator (ATC/PC) or the Trainer Assessor may submit the application on their behalf.

All special considerations will be applied in line with RLSS UK policies. A copy of outcomes may be sent to the ATC/PC for their records, who will be required to retain them for audit team and regulatory requirements.

Please complete the application form including as much information as possible to allow RLSS UK to make a valid and reasonable judgment of individual circumstances.

**If you are applying for more than 3 people please contact the compliance team at [email protected]**

Part 1 Candidate Details

Candidate Name (required)

Candidate Email (required)

Candidate Date Of Birth (required)

Candidate Society Number

Candidate Telephone Number (required)

Part 1A Applicant details (If different to candidate details)

Applicant Name

Applicant Email Address

Applicant Telephone Number

Part 2 Qualification Details (only complete sections applicable to your application)

Qualification (required)

Qualification expiry date (required)

Qualification Status and Level (New/renewal/probationary) (required)

Valid Continued Professional Development - Total Hours (CPD)

Part 3 Details of the special consideration

Reason for the special consideration (Provide as much detail as possible) For example: I broke my arm two days before my assessment, the break in my arm required a cast which I cannot get wet for six weeks. (required)

Summary of evidence to support your application (eg hospital or doctor letter) (required)

Part 4 Outcome you sought

Outcome sought (For example: Allow me to take my assessment as a renewal candidate after my original qualification has lapsed.) (required)

Proposed Assessment Date (required)

ATC/P Venue (if known)

Presenting Trainer (if known)

Assessor (if known)

Part 5 Confirmation

By submitting this form I confirm that

1. The contents of this form reflect accurate details of the special conditions to be made
2. I have included all relevant evidence and times frames to be considered
3. I agree to the RLSS UK privacy policy (www.rlss.org.uk/privacy-policy)

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