STUDENT SUPPORT & WELLBEING
2014/2015
You have notified the University of Kent that you have a disability/specific learning
difficulty/mental health difficulty or medical condition and we therefore request that
you complete this registration and consent form.
Student Name
(Full Name)
UCAS Application
number or Student ID
Description of
disability, specific
learning difficulty,
mental health difficulty
or medical condition
Academic course
Campus
(Canterbury/Medway/
Tonbridge/Other)
Address
Part-time or full-time
Home telephone
Mobile telephone
Date of Birth
E-mail Address
In order for Student Support and Wellbeing to help with the planning of your support at the
University of Kent you must provide medical evidence in the form of a doctor’s letter or a
consultants letter, or if you have a Specific Learning Difficulty e.g. dyslexia, please provide
an Educational Psychologist’s Report or a Specialist Teacher’s Assessment Report as
evidence of this.
UK students (Only)
Disabled Students’ Allowances (DSAs) may help you to secure additional support when
studying for your course, as a direct result of your disability, specific learning difficulty (e.g.
dyslexia), mental health difficulty or medical condition. For more information on how to
apply, contact Student Finance England, Wales, Northern Ireland or Student Awards
Agency for Scotland (https://www.gov.uk/disabled-students-allowances-dsas).
Do you intend to apply for the DSA Allowance or have you already started this process Y/N
International Students (Only)
Please contact Student Support & Wellbeing to discuss the level of support you will require at the
University of Kent. You must supply some form of medical evidence OR documentation
regarding your circumstances translated into English
Do you have access to
funding which will help to
meet the costs of your
personal support and / or
equipment?
Y / N
Please send us documentation to confirm the
funding arrangements
FOR ALL APPLICANTS - PLEASE READ WITH CARE
STUDENT SUPPORT & WELLBEING
Your consent is requested for the following in accordance with Registration/Notification
under the Data Protection Act 1998:
Part A)
To hold all your personal information regarding your disability/specific learning difficulty/mental health
difficulty/medical condition on a manual file. To maintain electronic records of your support needs on the
Student Data System.
Part B)
To appropriately disclose relevant parts of this information to the following:
 Other members of staff for the planning, delivery, monitoring of support
 Student Loans Company / Student Finance
 DSA Assessment Centre
 Educational Psychologists and /or Specialist Teacher Assessors
Part C)
To give permission for SSW (Student Support and Wellbeing) to obtain relevant documentation from your
Academic Department
Part D)
To include your e-mail address in the Student Support & Wellbeing e-mail list for latest up to date
information regarding our Service
Please sign the section below if you are in agreement with parts A, B C and D
I agree with parts A, B, C and D outlined above.
Signature ___________________________ Date ________________________
OR
Part E) Student Consent Disclaimer
If you do not consent to information being entered onto the University Student Data System then please
sign this section. This will result in Departments being unaware of your individual circumstances or of any
Inclusive Learning Plan created.
Signature ________________________ Date ________________________
Please send this form to:
Student Support & Wellbeing
Keynes College
University of Kent
Canterbury
Kent CT2 7NP
Telephone: +44 (0)01227 823158
Email: accessibility@kent.ac
www.kent.ac.uk/studentsupport
www.kent.ac.uk/studentwellbeing