DSA Booking Form

Preferred Pronouns

Name

First

Last

Preferred name

Date of Birth

(30/06/24)

Mobile Number

Email

Confirm Email

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Please select the categories of your disability

Your disability or learning difficulty

College

Campus

Campus (copy)

Undergraduate or Postgraduate

Name of course

Full time or part time

Month course started

Year course started

Month course ends

Year course ends

Funding body

Student reference number

Please upload your DSA eligibility letter

Click or drag a file to this area to upload.

Medical evidence

Click or drag a file to this area to upload.

Medical evidence 2

Click or drag a file to this area to upload.

Medical evidence 3

Click or drag a file to this area to upload.

How would you like your assessment to take place?

Are you happy for us to share your assessment info with your Learning Support Team? Would you be happy for us to send your name, DOB and assessment date/time to your Learning Support Team as this may allow them to contact us and provide related information/support to refer to during your assessment.

Would you like a member of your family, partner, carer, or another advocate to discuss DSA matters with us?

Please confirm you are happy for us to hold/process your data in compliance with our GDPR/Privacy Policy

Read Privacy Statement

Additional Requirements

DSA Booking Form

Contact Details