Student Information Form

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Student Information Form

The information you provide on this form helps the Accessibility & Accessibility and Disability Resource Centre (ADRC) to work with you and your College and Department/Faculty to arrange your academic-related access requirements. Please complete as much of this form as possible and return it to the ADRC. Completing this form, and sending in supporting documentation will help us in starting the process of arranging your academic-related access requirements.

This form is available in alternative formats on request, including Braille. Guidance notes and an electronic version of this form are available at Information for Incoming Students | Accessibility and Disability Resource Centre (cam.ac.uk)

Section A: Your personal details

First name

Preferred Name

Surname *

Please enter a value for Last name.

Preferred Pronouns

Date of Birth *

Please select a value for Date of Birth.

E-mail Address *

Please enter a value for E-mail Address.

UCAS No.

USN (Post-Grads only)

CRSID

Course

Month/Year of entry *

Please select a value for Month/Year of entry.

College

A1. Nature of your disability, impairment or medical condition (please tick all those that apply)

You have a social/communication impairment such as an autism spectrum condition

You are blind or have a visual impairment

You are deaf or have a hearing impairment

You have a long standing illness or health condition

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

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

You have physical impairment or mobility issues

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

Section B: Confidentiality Agreement

Once you have read the ADRC Confidentiality Policy, please complete and sign the following Confidentiality Agreement.

Confidentiality | Accessibility and Disability Resource Centre (cam.ac.uk)

Choose one option only:

If you have selected a restricted disclosure, to which identified groups (choose one option only):

ADRC Only

College

University

B1: Recording of lectures, seminars and supervisions agreement

In July 2022 the General Board’s Education Committee issued a Statement of Expectation for lecture capture recording. This Statement outlines an institutional aim to provide recordings for all lectures as standard. Therefore, in most cases recordings of lectures should be available to students within Moodle. However, there may be some circumstances where students may still need to make recordings.

Please find details of the agreement for the recording of lectures, seminars and supervisions here. We advise that you read the provisions of the agreement and indicate below that you will follow them. We will keep a record of your agreement.

I have read the provisions of the agreement for the recording of lectures, seminars and supervisions and agree to follow them.

Section C: Your academic-related disability access requirements

C1: Please tell us more about your disability/impairment and how it affects your studies.

Please also attach relevant supporting documentation to this form (e.g. Educational Psychologists assessment, audiology report, or medical letter/report), where available - file uploads can be done at the bottom of the form in section D.

C2. What support did you receive at school, sixth form, college or other further education or higher education institution, including examination access arrangements?

C3. Lectures, seminars and supervisions

Please describe any support or access requirements you would need in lectures, seminars and supervisions (tutorials). Examples of support can be found on the ADRC website click here to view.

C4. Human Support / Non-Medical Help (NMH)

The ADRC will contact you to discuss access requirements, including possible human support. If you have had support previously or feel that this would be useful for you, please describe that support and the reason for that support below.

More information is available online at: Non-Medical Help (NMH) - Human Support | Accessibility and Disability Resource Centre (cam.ac.uk)

C5. Libraries

Are there any adjustments or requirements you would find useful in order to access and use libraries? Examples can be found here on the ADRC website click here to view.

C6. Practicals, field trips and placements

Please detail any adjustments or access requirements which you may need in practicals (for example in laboratories, fieldtrips or placements click here.

C7. Examination Access Arrangements (EAAs)

Please note that specialist evidence is normally required for requests for examination access arrangements.

Your College Tutorial Office will apply for any access arrangements for examinations you require, usually based either on medical evidence or on a full diagnostic report written by a Practitioner Psychologist or Specialist Teacher. The ADRC does not apply on your behalf but we can make recommendations.

You will need to provide your evidence to your College and ask them to apply on your behalf. Please be aware that deadlines exist for the submission of this evidence. We advise that you provide this in the first term of the academic year.

Please see the ADRC website for further details and important information about the application process for exam access arrangements: Exam Access Arrangements | Accessibility and Disability Resource Centre (cam.ac.uk)

Extra Time

Use of a word processor

Examination paper in alternative format

Loop / infrared system for hearing aid

Examinations in a separate room with one-to-one invigilation

Examinations in a smaller room with low student numbers

Specialist ergonomic seating

Rest or nutrition breaks

Please provide any additional information here:

C8 Do you require any of the following?

Please add a brief description here:

Section D: Your disability-related funding

Disabled Students Allowances (DSAs) are available to support UK disabled students, for other specialist human support, travel and equipment/software. Further information on eligibility and application is available here Help if you're a student with a learning difficulty, health problem or disability: Disabled Students' Allowance - GOV.UK (www.gov.uk)

The ADRC also has internal funds which may be able to support you. Your adviser will discuss this with you. More information on funding is available on the ADRC website: Funding your support | Accessibility and Disability Resource Centre (cam.ac.uk)

If you have any questions related to this please email disability@admin.cam.ac.uk or phone 01223 332301

1.Supporting Evidence

Choose file

Type

2.Supporting Evidence

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Type

3.Supporting Evidence

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Type

4.Supporting Evidence

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Type

5.Supporting Evidence

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Type

Please ensure all fields marked with a * have a value before submitting this form.

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Friday 9am-4pm

Accessibility and Disability Resource Centre

Student Services Centre

Bene't Street

Cambridge, CB2 3PT

01223 332301

disability@admin.cam.ac.uk

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