Prospective student online form

This form is for completion by our prospective students so that we can learn more about you.

Please complete the form below to let us know about any specific requirements you have while you are at the University. If you are unsure whether your supporting evidence is appropriate, please upload it and we can advise you if we will need anything further.

We encourage you to complete the form as soon as possible, especially if you require adjustments such as practical assistance during your studies, specific equipment to be in place when you start, or if you need adaptations to your accommodation such as a hoist.

Informing us of your consent

Please note we are a student-led service. Depending on your individual support requirements your information may be shared with the following people as appropriate:

Your College
Exams Team
Accommodation and Estate Team
Health and Safety Office

Ensure you read the following with regards to how your information may be shared with other staff within the University - Declaring a Disability or Health Condition. Please see our Privacy Notice if you have any queries with regards to your personal data.

Advice for parents and supporters

Please see these helpful web pages for further information, advice and guidance.

Funding information

For information, advice and guidance on funding your support while at University, including details on the Disabled Students’ Allowances (DSA), please see our webpage explaining how to claim DSA and more.

Future correspondence

Any correspondence we send you will be sent to the email address you used in your UCAS application (or your direct application if you didn’t go through UCAS). Please ensure this is your personal up-to-date email address, as otherwise you may not receive important updates from our advisors. Please click here for instructions on how to update your email address with UCAS.

Personal details and course information
First name: *
Surname: *
Pronouns:
Exeter Reference Number: e.g. 712345678
Date of birth e.g. 20/09/1988: *
Email address: * ?	This email field allows us to send you an automatic confirmation email with further information when your form has submitted. Please be aware that any future email communication will be sent via the email address you put on your UCAS application form. You can update your email address on UCAS track if helpful.
Mobile number: *
Course name: *
Which campus will you study on? *
If you are a prospective student applying to Penryn campus, please do not fill out this form and instead follow the instructions here to set up your support: https://studyhub.fxplus.ac.uk/accessibility-inclusion/ilps/accessibility-information-exeter-applicants
Start date: *

Your condition and how it impacts you
1) Please complete the following declaration by ticking the relevant disability/health condition. You can select more than one. *	No known impairment, health condition or learning difference Social/communication conditions such as a speech and language impairment or an autistic spectrum condition Blind or have a visual impairment uncorrected by glasses Deaf or have a hearing impairment Long-term illness or health condition such as cancer, HIV, diabetes, chronic heart disease, or epilepsy Mental health condition, challenge or disorder, such as depression, schizophrenia or anxiety Learning difference such as dyslexia, dyspraxia or AD(H)D Physical impairment (a condition that substantially limits one or more basic physical activities such as walking, climbing stairs, lifting or carrying) An impairment, health condition or learning difference not listed above Developmental condition that you have had since childhood which affects motor, cognitive, social and emotional skills, and speech and language Prefer Not to Say Disability - prefer not to say
2) Please describe your medical condition/physical disability/mental health diagnosis or specific learning difficulty: *
Please tick the main areas affected by your medical condition/physical disability/mental health diagnosis or specific learning difficulty: *	Fluctuations in mood Fluctuating anxiety levels Concentration Motivation Confidence Energy levels/fatigue Reading speed & accuracy Note taking Organisation Co-ordination Handwriting Processing speed Short-term memory Communication/social difficulties Physical health Attendance Heightened stress in relation to deadlines Sleep Eating & appetite Presentations Participation in class discussions Answering questions in class Establishing a routine

Adjustments at University
3) Have you had any academic adjustments previously? Please note these will not automatically continue at the University. *
Please tick any previous access arrangements you have received for examinations: *	Extra time Reader/scribe Computer use Rest breaks Separate room Smaller room Alternative formats Other (please specify below under question 5)
4) Does your health condition/disability have a significant impact on your accommodation requirements, e.g the location and accessibility, type of room, adaptions needed, catered or self catered? Please give details. *
5) If you would like to give us any further details about your support requirements or previous support you have received, please do so here: *

Additional information
6) Are you being supported by a mental health service or practitioner (eg. Doctor, psychiatrist, Community Mental Health Team or other relevant services)? *
Please give further details: *
7) Have you received support from a mental health service or practitioner over the past 2 years? *
Please give further details: *
8) Have you previously taken time out from or repeated your studies for health related reasons? *
Please give further details: *

Supporting evidence upload field
Please ensure you upload supporting evidence with this form as otherwise we will not be able to process it. (If you are unsure what you need to submit, have a look at our Supporting Evidence Guidance webpage: https://www.exeter.ac.uk/students/wellbeing/support/medicalevidence/)
Please upload any relevant supporting evidence here: *
Further evidence:	+
Further evidence:

Health and Safety
9) In the event of an evacuation are you able to (at all times, including during a medical episode such as a seizure): A) Independently leave the building in a reasonable time, including use of stairs? *
B) Hear the fire alarm, at all times (including during a medical episode such as a seizure, and when in bed and in the shower)? *
C) If you've answered 'no' to question A) or B) above, please give further details: *

Declaration
I confirm that the above information is correct to the best of my knowledge and that I have read the document ‘Declaring a Disability or Health Condition’ . I will inform Wellbeing Services of any change in my circumstances. I consent to my information being shared as outlined above. *

Prospective student form

Prospective student online form

Informing us of your consent

Advice for parents and supporters

Funding information

Future correspondence