Sensory Impairment Support Needs Form
Full Name
Date
Email
Phone Number
Type of Sensory Impairment
Visual Impairment
Hearing Impairment
Dual Sensory Loss/Deafblind
Other
Description of Impairment/Diagnosis (if applicable)
Current Support In Place
Additional Support Needed
Preferred Communication Methods
Access Requirements (e.g. equipment, materials, environment)
Other Notes