Application for Services for Students 
with Learning Disabilities
Academic Year 2018/2019

By 30th September 2018, fill in and deliver this document to the Disabilities and Learning Disabilities Service
•	by email to disabilita@unive.it
•	by hand on Tuesdays, Wednesdays, and Fridays from 9:30 to 12:30 and Wednesdays also from 14:30 to 16:30.

First name		
Last name		
Registration number		
Degree level	☐Bachelor of Arts (BA)
☐Master of Arts (MA)
☐Doctor of Philosophy (PhD)	
Enrolled in	☐First (1st) year
☐Second (2nd) year
☐Third (3rd) year
☐outside the prescribed term – please specify

	
Total of university credits 
by 10th August 2018		
Landline		
Mobile number		
Email address		
Emergency Contact Person		

Please note: Ca’ Foscari University of Venice will provide the following services by taking into consideration the type of learning disability, the students’ merits and the financial resources. Once the students have received these benefits, they must use an online platform to make all of their requests for each academic year.

Type of disability	☐dyslexia
☐dysgraphia
☐dysorthographia
☐dyscalculia
☐other – please specify

Degree of severeness (if known, please specify)	
Services requested	☐technological tool to take exams
☐accessible exams
☐accessible study materials
☐collection of classes’ notes
☐tutoring for didactic reasons
☐other (please specify)	

I (first and last name)

require access to services for students with disabilities made available by Ca’ Foscari University of Venice for the academic year 2018/2019 in accordance with the type of disability and learning disabilities. I am aware of the criminal sanctions referred to in article 76 of the Decree of the President of the Italian Republic n° 445/2000 for false statements. 

I state that:

☐ I have provided Ca’ Foscari University of Venice wit ha copy of all the supporting evidence to document the disabilities for which I request accommodations,
☐ what is attested in the documentation has not been revoked, suspended, or modified (Italian Legislative Decree dated 02/09/2012, n°5, article 4, clause 2),
☐ I am already regularly enrolled in the academic year 2018/2019, or will be enrolled by 30th September 2018,
☐ I authorize the processing of personal data pursuant Article 13 of Italian Legislative Decree n° 196 dated 30/06/2003 (information is available online at http://www.unive.it/pag/8249/) and in compliance with the relative adjustments to the European Union Regulation 2016/679 “General Regulation on Data Protection” on the protection of personal data.

We inform you that
•	to better help students with disabilities and learning disabilities and improve services to and for them, we can process data about their careers,
•	to protect the privacy and safety of data, we can treat them by hand, informatically, and electronically,
•	the responsible for the treatment of data is Ca’ Foscari University of Venice, in Dorsoduro 3246, 30123, Venice, Italy.

Date and place							Signature

For further information, please contact 041 23 47 961 or disabilita@unive.it