First Name(s) (required)
Date of Birth (required)
Phone Number (required)
Name of Course (required)
Please tick the appropriate box:
Specific learning difficulty (e.g. dyslexia)
Asperger syndrome, autistic disorder or social communication difficulties
Long standing illness or health condition (e.g. diabetes, epilepsy)
Mental health issues including self-harm and suicidal thoughts/actions
Past/current drug use
Physical disability/Mobility difficulties
Other disability – Please state:
Please provide the name of your disability below:
Has your disability, mental health condition, specific learning difficulty or medical condition been established by any of the following?
School or College
Your own experience
We require a copy of any evidence you have of your disability, mental health condition, specific learning difficulty or medical condition (e.g. Educational Psychologist’s Report, Statement of Educational Needs, Needs Assessment, Medical Report.) This will help us to speed up the process of ensuring you receive the support – thank you.
I will attach a piece of evidence belowEvidence is to follow
If you are providing evidence please attach here
If you require reasonable adjustments to be implemented while studying at University Campus Oldham, then you will need to book an appointment with the Disability/Mental Health and Wellbeing Officers to further discuss your support needs and enable a Learning Support Plan to be created. This will ensure that the relevant members of staff are aware of your needs and reasonable adjustments may be made whilst you study at University Campus Oldham
Please be aware that if you require a Personal Emergency Evacuation Plan (PEEP), a Learning Support Plan or want to apply for exam concessions due to your disability then you must arrange an appointment with the Disability Officer.
Yes – I require a meetingNo – I do not require a meeting
Please complete this section of the form to indicate your consent for the Disability Service to hold information about you and your disability and to disseminate this information to relevant individuals and organisations. The purpose behind this is ensure the necessary support and adjustments are in place during your studies.
The type of information we hold includes (but is not limited to):
Examples of individuals and/or organisations to whom we may disclose disability information:
I consent to information being held and disclosedI do not consent to information being held and disclosed
UCO operates a confidentiality policy and information will be passed on appropriately and only with your consent. There may be rare circumstances where information about your disability is disclosed without your consent, for example if there is concern that you are at risk. This will only be done in circumstances permitted by the Data Protection Act 2018.
If you do not consent to information about your disability being held and shared, the University may not be able to fully support your requirements.
Disabled Student’s Allowance (DSA) – UK students only
The DSA helps to pay for extra costs you may have as a direct result of your disability. The allowance can help with the cost of an academic support worker, items of specialist equipment, travel and other course related costs.
Further information and the application form can be obtained on the website at:
Have you applied for the Disabled Students’ Allowance?
Support is available for students not from England, overseas students and those not applying for or not eligible for DSA. Please contact us to discuss this further.
I acknowledge that the information I have given on this form is true and accurate.
If you would like any further information, please contact the UCO’s Disability Officer:
Tel: 0161 344 8877
This form is also available in alternative formats. Please contact us and let us know your preferred format.