Student Support and Wellbeing registration form

Student Support and Wellbeing Registration Form
Student Type
Student Name (Full name)*
Student preferred name
Pronoun

She/HerHe/HimThey/ThemOther
Location*
Are you a Higher and Degree Apprenticeship student?

YesNo
Are you a Care Leaver?*

YesNo
Are you an International Student?*

YesNo
Will you be newly joining the University in September 2025?*

YesNo
Do you require a wheelchair accessible meeting room?*

YesNo
Do you require a BSL interpreter for your meeting?*

YesNo
Student Number
Course*
Academic School/ Department*
Your email address*
example@kent.ac.uk or example@gmail.com
Mobile telephone*
Date of birth

DayMonthYear
I would like to seek support as a Care Leaver

YesNo
If applicable, I have notified the University of Kent of my disability/specific learning difficulty/mental health difficulty or medical condition via UCAS or in my PG application:*

YesNo
If you would also like to seek support for any of the following reasons, please tick all those that apply:*

I have a diagnosed Specific Learning Difference (e.g. dyslexia, dyspraxia)I think I have a Specific Learning Difference (e.g. dyslexia, dyspraxia)I have an AD(H)D diagnosisI think I may have AD(H)DI have a diagnosis of AutismI think I may have AutismI have a diagnosed Mental Health conditionI would like help with a new/emerging Mental Health conditionI am partially sighted or blindI have a condition affecting my mobilityI have a long-term health condition (e.g. IBS, diabetes, fibromyalgia, asthma, epilepsy, sickle cell anaemia)I am a refugee /asylum seekerI have experienced recent trauma/bereavement/lossI am care experienced or a care leaverI am a care giverI am an estranged studentOther
If AD(H)D, is this diagnosed?

YesNoN/A
AD(H)D referral*

I have been referred for an AD(H)D AssessmentI have not been referred for an AD(H)D Assessment
Autism Assessment referral*

I have been referred for an Autism AssessmentI have not been referred for an Autism Assessment
Please give a brief description of the above and any adjustments you’ve previously had in an educational setting*
In order for Student Support and Wellbeing to help with the planning of your support at the University of Kent, where relevant you may be asked to provide medical evidence in the form of a doctor’s letter or a consultant’s letter, or if you have a Specific Learning Difficulty e.g. dyslexia, please provide an Educational Psychologist’s Report or a Specialist Teacher’s Assessment Report as evidence of this. (Where necessary, this evidence needs to be formally translated into English)

Consent

Please read the Student Support and Wellbeing Privacy Notice and confirm your consent by ticking below:
Privacy notice*

I confirm that I have read the Student Support and Wellbeing Privacy Notice and I consent to Student Support and Wellbeing holding and processing personal information about me in relation to my support. I also consent to this information being processed as described above.
Student Name*
Date*

DayMonthYear
Should be Empty:

Student Support and Wellbeing Registration Form