Pre-DSA needs assessment form

To confirm a DSA needs assessment interview appointment we require:

a copy of the letter confirming DSA eligibility. This letter will have come from Student Finance England or Wales, NHS Bursaries, Student Awards Agency Scotland, or a postgraduate research council.
a copy of the evidence of disability used to apply for DSA.

If you have not already sent us these two pieces of information please email them to admin@sass-ltd.co.uk or post a copy to SASS Ltd, Unity 12, 9-19 Rose Road, Southampton SO14 6TE.

More information on what you need to do before booking a DSA assessment.

We require some details for our records.

Our privacy policy explains why we collect this information.

Please complete the form below, or download the form in Word 2010, Word 1997-2003, or Acrobat pdf format and return to us by email or post.

Contact details

First name

Surname

Email address

Phone

Alternative phone

Address

Home address

Street 1

Street 2

City

Postcode

Country

Student / alternative address

Street 1

Street 2

City

Postcode

Country

Course

University / college

If you do not have a confirmed place please indicate first choice or most likely.

Course

Attendance Full-time Part-time

Student level Undergraduate Postgraduate

Year of study

Not started yet
Year 1
Year 2
Year 3
Year 4
Year 5
Year 6

Disability

What type of disability are you being assessed for (you will find this in your funding body approval letter)?

Additional information

The following information would help us to prepare for your needs assessment interview.

Have you had a DSA needs assessment in the past? If yes, please give details of date, the course/university.

General information about the effects of your impairment, disability or medical condition.

For example: side effects of medication, fluctuation in symptoms, more apparent under certain circumstances such as if required to walk long distances.

What type of support have you received in the past (e.g. in school/college)?

What type of equipment do you have access to (e.g. computer, tablet, smartphone)? Please provide details of the make and model of each.

Are you happy for us to contact the university disability support staff regarding details of existing arrangements?

Yes
No
Not sure - prefer to discuss in DSA needs assessment

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