To request a DSA Needs Assessment please complete the online form below.

We will contact you shortly afterwards to offer suitable dates and times. Please note that the assessment fee is inclusive (to include any Top-Up assessments).

Alternatively, if you would prefer to call us on 01522 886400, we will be happy take your details over the telephone.

  • All information you provide will be held in strict confidence.
  • You do not have to complete all the questions, but please ensure that you at least provide us with your name and contact details.

First Name

Surname

Date of birth dd/mm/yyyy

Email Address

Home Address

Home Telephone Number

Mobile Telephone Number

Term-time Address (if different from home address)

About your disability and local authority

Has your funding body already agreed to you having an assessment of needs?
 Yes No Not sure

What is your disability or medical condition? (if more than one, please list them all.)

About your chosen Course/University

What is the name of your chosen University?

What is the name of your chosen course?

What year did you, or will you, first enrol on your chosen course?

Please use this box to include ANY other information you would like to add