Disability disclosure

This form can be completed by students at the University of Plymouth so that they can disclose their disability (or disabilities) and appropriate support can be put in place.

You have received a link to this form because you have indicated to the University of Plymouth that you are disabled.

About Disability

You are considered to be disabled under the Equality Act 2010 if you have a physical, neurological developmental or mental impairment that has a ‘substantial’ and ‘long-term’ negative effect on your ability to do normal daily activities.

An impairment or condition is considered to be long-term if it has lasted for at least 12 months, is expected to last for at least 12 months, or is likely to last for the rest of your life.

For a student, ‘normal day to day activities’ might include taking notes, writing, researching, reading large amounts of text and moving between multiple locations.

Declaration of your disability(s). Please tick ALL boxes below that apply: *

You have a social/communication impairment such as Asperger's syndrome/other autistic spectrum disorder

You are blind or have a serious visual impairment uncorrected by glasses

You are deaf or have a serious hearing impairment

You have a long-standing illness or health condition such as cancer, HIV, diabetes, chronic heart disease, or epilepsy

You have a mental health condition, such as depression, schizophrenia, or anxiety disorder

You have a specific learning difficulty such as dyslexia, dyspraxia, or AD(H)D

You have physical impairment or mobility issues, such as difficulty using your arms or using a wheelchair or crutches

You have a disability, impairment or medical condition that is not listed above

Your details

What is your student registration number (SRN)? *

Please tell us your name *

Date of birth * +

Email address

Consent to share

I agree to an exchange of relevant information about my disability and/or support requirements, including my DSA report if appropriate, being disclosed to those faculty, teaching, professional and administrative staff who have a need to know and to relevant external providers of support (e.g. suppliers who provide non-medical helpers i.e. mentors, study skills tutors etc.) and Disabled Student Allowances (DSA) Needs Assessment Centres.

If I am undertaking a professional programme, I understand that this information may be shared with external Occupational Health providers.

Further information can he found on our website via the following links:

> Disclosure and GDPR information.
> Student Services Privacy Statement. *

Yes

I do not agree but I understand that if I do not agree to disclosure about my disability this may limit the support I receive. *

I understand

If you are unsure about giving your consent or wish to discuss this disclosure with us please contact Disability Inclusion Services as soon as possible on 01752 587676 to avoid delays in processing

Sign, date and submit

Your digital signature *

clear

Today's date * +