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Case Note?

Case note completed?

Yes

Disability Inclusion

Keep?

Yes

Have you confirmed receipt in SID?*

Yes No

Have you updated SID Case Notes?*

Yes No

Does the student require support?*

Yes No

Does the student have appropriate evidence?*

Yes No

Have you entered the adjustments into SITS?*

Yes No

Notes

Name*

First Name

Last Name

Pass on?

MHST Student Life Learning Support No

MHST

Keep?

Yes

Have you confirmed receipt in SID?*

Yes No

Have you updated SID Case Notes?*

Yes No

Does the student require support?*

Yes No

Does the student have appropriate evidence?*

Yes No

Have you entered the adjustments into SITS?*

Yes No

Notes

Name*

First Name

Last Name

Pass on?

Student Life Learning Support No

Student Life

Keep?

Yes

Have you confirmed receipt in SID?*

Yes No

Have you updated SID Case Notes?*

Yes No

Does the student require support?*

Yes No

Does the student have appropriate evidence?*

Yes No

Have you entered the adjustments into SITS? *

Yes No

Notes

Name*

First Name

Last Name

Pass on?

Learning Support No

Learning Support

Keep?

Yes

Have you confirmed receipt in SID?*

Yes No

Have you updated SID Case Notes?*

Yes No

Does the student require support?*

Yes No

Does the student have appropriate evidence?*

Yes No

Have you entered the adjustments into SITS? *

Yes No

Notes

Name*

First Name

Last Name

Student Support Questionnaire

Please complete this form as fully as you can. The information you provide will help us to understand more about any support you may need at the University of Hull and put in place adjustments for you.

What will happen next?

Once you submit the form, it will be sent to our Student Support teams, who will contact you with further information about what can be put in place. You may be given an appointment with one of our Support Teams to discuss your needs in more depth. In some cases we may request further medical evidence.

Personal Details

Name*

First Name

Last Name

Student/Applicant Number*

This is the 9 digit number you will have received by email (applicants) or you can find it on your student card (enrolled students)

Date of Birth*

Email Address*

Phone*

Your Course

Course Name*

My course is...*

Undergraduate Full time Undergraduate Part time Postgraduate Full time Postgraduate Part Time

Other:

To help us to understand what type of adjustments and support are relevant to your situation/programme of study, please tick if any of the following are applicable:

Hull online student Apprenticeship  student Hull York Medical School student International student None of the above

Hull Online courses are taught entirely online.

Please unselect this option if you study on campus.

Are you studying on a Student Visa?*

Yes No

If York is your lead University please do not complete this form. Please email studentwellbeing@hyms.ac.uk for further guidance.

Information about your support needs

If you have selected more than one disability/condition, please let us know if you consider one to have a bigger impact on your studies

Please provide any further information relating to your condition that might help us support you, e.g. the name of your condition, impacts of any medication you take, any support received during education previously*

Adjustments in the teaching and learning environment (e.g. lectures, seminars, practicals)

It is important for us to know about your individual learning needs; for example if you require adjustments in lectures.

Please note, as an inclusive University some of the following adjustments may be available as standard to all students.   We’d still like to know if these arrangements will be especially helpful for you in relation to your condition.

Please tick any options that you think you will require to address challenges you face as a result of your disability/condition.

I would like lecture materials (e.g. digital copy of presentation slides) to be made available in advance*

Yes No

I need lectures to be recorded and/or I need to be able to record the lecture (e.g. using a digital recorder or smartphone)*

Yes No

Please Note: some lectures are recorded as standard using a lecture capture system called Panopto, however this isn’t currently available for all lectures

I may need to take a short break from the teaching and learning activity, and would like teaching staff to be made aware of this.*

Yes No

My disability/health condition may sometimes impact on my attendance*

Yes No

You can report these absences in the University's engagement system; SEAtS

If you are studying on a Student Visa, any absences must be authorized by our International Engagement and Compliance Team.

You can find the Authorised Absence Form here.

I may need extensions to coursework deadlines due to my disability/health condition *

Yes No

I need adjustments to be considered if I am required to deliver a presentation*

Yes No

Please describe what adjustments would be helpful*

I need printed materials to be available in a digital/alternative format *

Yes No

Please specify the format you require*

I need adjustments to be considered if my course requires me to do a placement or go on a fieldtrip*

Yes No

Please describe what adjustments would be helpful*

My disability/health condition may have implications for my safe participation in labs/practicals. Please consider adjustments or complete an individual risk assessment for me*

Yes No Not applicable

Please provide further details*

I would like teaching staff to be made aware about the specifics of my disability/health condition*

Yes No

Please write what you would like them to know *

Please note, in some cases, for example where there are health and safety considerations, we may be required to share details of your condition even if you have not provided consent.

I need to be made aware of the any essential reading I need to do for modules in advance of the start of the module (e.g. if reading may take you longer)*

Yes No

Physical Accessibility

I require all on campus lectures, seminars and exams to be scheduled in accessible rooms (i.e. is at ground floor level or with lift access)*

Yes No N/A

I am a wheelchair user*

Yes No

I am able to self-transfer*

Yes No N/A

I would like you to send me information about disabled parking on campus*

Yes No N/A

I would like you to send me information about campus accessibility*

Yes No N/A

Hearing Loss

I require subtitles/closed captioning on any audio visual materials used in class*

Yes No

Do you wear a hearing aid?*

Yes No

Is this compatible with a hearing induction loop (does it have a telecoil)? *

Yes No Not Sure

I require a hearing induction loop in lecture theatres*

Yes No

I lipread and request that teaching staff are made aware of this*

Yes No

I use British Sign Language*

Yes No

Examination Adjustments 

The University uses a range of different assessment methods.

For courses that assess using timed examinations, these may take place on campus (handwritten or digital) or off campus (digital). Some courses do not include timed examinations. We try to apply reasonable adjustments as consistently as possible but there may be slight variations depending on the type of examination format.

If you know at this stage that your course definitely does not include timed exams, please indicate this here.*

I do have timed exams I don't have timed exams I am unsure

Please check the box if you do not wish to apply for exam adjustments.

I do not wish to apply for exam adjustments

Please provide details of any challenges you may experience in an exam situation, any adjustments or support you have received previously, or any other information you think it is important for us to be aware of. *

Do you require Extra Time in exams?*

Yes No

Extra time in examinations is usually 15 minutes extra per hour. Is 15 minutes per hour OK for you? *

Yes No

Please tell us how much extra time per hour you need and why, so that this can be considered further.*

Do you need rest breaks in exams? *

Yes No

Rest breaks are usually 5 minutes extra per hour. Will 5 minutes per hour be OK for you? *

Yes No

How much extra time per hour do you need and why?*

For exams which would usually be handwritten, I will require use of a computer to type*

Yes No

I would like to discuss the possibility of using assistive software (e.g. text-to-speech or dictation software) for digital assessments*

Yes No

What type of Assistive Software would you require?*

For on campus exams, the above arrangements usually take place in a smaller exam room with up to 40 students. Will this situation be manageable for you?*

Yes No

Please tell us why the examination setting described above would not be manageable for you*

Accommodation

Once you've selected Hull as either your firm or insurance choice with UCAS you will receive an email confirming when the online accommodation application process is open.

There is the opportunity to disclose any health-related requirements when you apply (e.g. need for a ground floor room). We would strongly encourage you to disclose your requirements and to apply for accommodation as early as possible. For further information click here.

Will you be living in University (on-campus) accommodation?*

Yes No

Do you need personal care support? This includes any practical help or assistance you require for daily life, e.g. support with day-to-day activities such as washing, personal hygiene, getting dressed and domestic activities (e.g. shopping, cleaning, preparing meals, cooking)?*

Yes No

Please note that this type of support is not organized or funded by the university. It is usually provided by your home Social Services (UK students), who can undertake a social care/independent living assessment for you. It can take several months for an assessment and care package to be arranged and it is essential that you organize this support prior to coming to University. International students are not eligible for financial assistance with care costs from the British Government, and the University is unable to fund personal care support. It is therefore essential that you have included these additional costs in your budget, and that you have sufficient funding in place for the duration of your course before you come to the UK.

If the support cannot be arranged in time there may be instances, e.g. if we have overriding concerns about your wellbeing, when we would advise you not to move into our accommodation until the support is in place. If you have any concerns, please contact us as soon as possible and we will endeavor to help to speed up the process, or we can support you to defer your course start date until your care package is in place.

Please provide details of the type of support you need and whether you already have a social care package in place (or have started to make arrangements for this)*

Specific Learning Differences (SpLDs)

Conditions such as Dyslexia, Dyspraxia and ADHD are commonly known as Specific Learning Differences, or SpLDs.

Students who have SpLDs are supported by the Learning Support Team.

Specialist one-to-one specialist study skills support

Most UK SpLD students can apply for a Disabled Students' Allowance (DSA) from Student Finance England. If you are successful in receiving DSA, it can help you to study at university, and will usually fund support such as an excellent package of specialist one-to-one study skills support and/or a mentor, equipment, and specialist software.

If the SpLD evidence you have is not sufficient for DSA, we may be able to refer you for a diagnostic assessment with an Educational Psychologist which is acceptable evidence for DSA.

International students with SpLD, apprentices and students on short courses worth 40 credits or less are not usually eligible for DSA but you can still access a range of support and we will advise you about this. 

Do you feel that you need any specialist one-to-one study skills support and/or a mentor support for your SpLD?*

Yes No

Is there anything else you would like to tell us about your SpLD needs?*

Yes No

Please give details*

Upload any evidence you have below and we will check it and advise you on what you need to do next.

Further Information

Will your health condition have an impact on your health and safety attending campus or in student accommodation e.g. are there regular instances when you need first aid assistance, do you experience seizures or fainting episodes?*

Yes No

Please provide details*

We will consider the above information and may produce a Safety Support Plan for you. A Safety Support Plan would outline any potential risks to your health and safety and what the university can organize to address such risks.

We have Security staff on campus 24/7 who are first aid trained, however there are limitations in what can be provided and our support staff are not medical practitioners. Whilst the University will take all reasonable steps to consider your safety, this can only be done within reasonable expectations.

I have epilepsy/experience seizures

Please complete our Epilepsy Support Questionnaire.

Is there anything else you would like us to know so we can do our best to support you?

Supporting Evidence

Please provide supporting medical evidence e.g. a letter from your GP/medical practitioner, evidence from school or college about previous exam adjustments, an educational psychologist’s report or your DSA Assessment of Needs report, where possible. If you already have a care plan or independent living assessment report, we would also appreciate you sending us a copy. It is helpful if you can provide this now but please do not worry if you do not have any supporting evidence available at present. 

Please select one of the following:*

I have evidence and will upload it here  I will get hold of my evidence and send it to you via the My Hull Portal  Please advise me about screening for Specific Learning Differences (e.g. Dyslexia) I require further advice about how to obtain suitable supporting evidence

Other:

Please upload your evidence here*

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Please provide any information about your evidence you would like us to know

If you have more evidence you wish to send to us, please send this via the MyHull portal.

Declaration

The information you have provided on this form allows Student Support teams to provide a range of interventions, advice and guidance to help support your university experience. We will respect the sensitive nature of the information that you share with us and treat it in a respectful manner. Any information you provide us with will be stored securely within the University network. In general, your data and information will only be shared where we have a lawful basis to do so or with your consent. This information you have provided here will only be shared with staff across the university who have responsibility for reasonable adjustments or where it is required for the provision of educational activity. More information can be found in the Student Privacy notice (add link)

There may be certain exceptional circumstances in which we may disclose information to internal or external third parties without your consent, for example:

where there is an immediate and serious threat to your personal safety or to the safety of others
when not disclosing information would be breaking the law, e.g. under the Children Act 1989 or for the prevention, detection or prosecution of a serious crime under the Police and Criminal Evidence Act 1984
there is a concern regarding the safeguarding of children or vulnerable adults

In all cases, we will share the minimum information required to provide the support or adjustment.

Please select an option...*

I consent for the information I have provided to be shared with relevant staff in order that teaching and learning adjustments can be provided. I do not consent to the information I have provided to be shared with relevant staff and I understand this may prevent the university from providing reasonable adjustments I have concerns about information sharing and would like more information.

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Central Hub

Where to assign?*

Disability Inclusion MHST Student Life Learning Support No Support Required

Notes

Label

Central Hub - Case Note

Case Note Completed?*

Yes No

Name*

First Name

Last Name