Please note mandatory fields are marked with *
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Please tell us about the impact of your disability, mental health condition, specific learning difficulty or medical condition and how this affects or may affect your studies*:
We require evidence of your disability, mental health condition, specific learning difficulty or medical condition (e.g. Educational Psychologist’s Report, GP letter, medical report, audiology report, letter from a mental health practitioner etc.). This will help us to speed up the process of ensuring you receive the support – thank you.
Please contact us if you would like further information about what to include in your evidence.
Please complete this section of the form to indicate your consent for Disability Services to hold information about you and your disability and to disseminate this information to relevant individuals and organisations. The purpose behind this is to ensure the necessary support and adjustments are in place during your studies.
The type of information we hold includes (but is not limited to):
Examples of individuals and/or organisations to whom we disclose disability information:
The University operates a confidentiality policy and information will be passed on appropriately and only with your consent. There may be rare circumstances where information about your disability is disclosed without your consent, for example if there is concern that you are at risk. This will only be done in circumstances permitted by the Data Protection Act 1998.
If you do not consent to information about your disability being held and shared, the University may not be able to fully support your requirements.
Disabled Students' Allowance (DSA) – UK students only
The DSA helps to pay for extra costs you may have as a direct result of your disability. The allowance can help with the cost of an academic support worker, items of specialist equipment, travel and other course related costs.
Further information and the application form can be obtained on the website at:
If you are funded by the NHS, the application form can be obtained at the following link:
Have you applied for the Disabled Students’ Allowance?:
Support is available for students not from England, overseas students and those not applying for or not eligible for DSA. Please contact us to discuss this further.
Press submit to complete the Registration Form.
By submitting the form, I acknowledge the information provided is true and accurate.
If you would like any further information or help to complete the Registration Form, please email Disability Services at firstname.lastname@example.org with your query, including your contact details and preferred method of contact.
This form is also available in alternative formats. Please contact us and let us know your preferred format.
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