Student Support Referral Form - (out of UG term-time dates)

Student Support Referral Form - (out of UG term-time dates)

This form enables you to engage with the following teams in the Student Support department: Disability Support, Funding and Accommodation. Please scroll down to the Health and Wellbeing section for information on wellbeing support you could access when the service is closed outside of term-time.

You can declare a disability, neurodiversity, mental health condition and/or long-term health condition to Disability Support to request reasonable adjustments. You can also ask questions about funding and accommodation.

You will be guided through the form with questions from each team. To request support from a specific team, simply answer yes when asked about that aspect of support. You can contact as many or as few teams as you wish - only the teams you contact will receive your responses.

This form can be accessed and submitted multiple times. You can use it at any point in your studies to request support from a new team, or to declare new information to a team you are currently working with.

Average completion time: 5-10 minutes

General questions about you

First Name*

Surname*

Preferred name

If different from your registered first name

Student Support department use only

Student ID

e.g. WHI89098909

Email address*

Preferably your email address registered with Student Finance or your Leeds Conservatoire student email once received, e.g. WHI89098909@leedsconservatoire.ac.uk

Preferred pronouns

Student Support department use only

Course pathway*

Select

Please select your year of study*

Select

Are you a current, enrolled student at Leeds Conservatoire?*

Please only select Yes, I am a current/continuing student if you have completed enrolment in late September of the current academic year.

Please select No, I am a student who has suspended study if you are a returning student after suspending studies, or currently a student who has suspended their studies.

Please select No, I am an applicant if you are due to start at the conservatoire in the next academic year

Select

Disability Support at Leeds Conservatoire

Do you want to declare a disability, neurodiversity, mental health condition and/or long-term health condition to the conservatoire?*

In order to request reasonable adjustments, you must answer yes and complete the following section.

Information declared in this section will not be shared with the Health and Wellbeing Team, but please see their section below for information, advice and contact details if you have any questions before you enrol.

If you have already declared your disability and have no new information to share, please select no.

Select

Please declare any disability, neurodiversity, mental health condition and/or long-term health condition to the conservatoire*

This information can include relevant detail about your condition(s), which will be shared with academic staff if a Support Plan is made from this declaration

Adjustments to Teaching & Learning

To understand your disability and provide you with the most accurate guidance and support, we ask you to provide evidence of your condition(s) by attaching it below. This could be a letter from a GP, a psychological assessment, a diagnostic report, or evidence of exam adjustments from earlier education. We require this evidence before we can put exam access arrangements in place for you.

If you don't have anything, or are unsure of what to attach, please contact us at disability@leedsconservatoire.ac.uk

Drag and drop files here or

Have you had any exam access arrangements in previous education?*

Only select yes if you have previously had adjustments. Don't worry if not, it won't prevent you from potentially having adjustments at Leeds Conservatoire.

Select

Which adjustments did you have in place?*

Select all that apply, and Other if you had adjustments not listed

Select

Other unlisted adjustments?

Do not re-enter any adjustments selected above.

Have you applied for Student Finance and if so, who with?*

If you have chosen not to, or cannot apply for UK-based Student Finance, please answer using one of the options beginning with None

Select

Have you applied for Disabled Students' Allowance (DSA)?*

DSA is a government grant administered by Student Finance in England, Wales, and Northern Ireland, and SAAS in Scotland. It isn’t a loan, it isn’t means-tested and you don’t have to pay it back.

DSA support varies according to individual requirements, but can include specialist computer equipment, assistive software, study skills support, mentoring, or help with travel costs.

You can apply for DSA directly by clicking on the links to your relevant student funding body under the FAQs: What is DSA section on our website, alongside further information and a video guide on how to apply.

Please note, if you require personal care support due to a disability, long-term health condition, or mental health condition, this will be provided by your local authority - not DSA or Leeds Conservatoire. We would advise that you contact your local authority as soon as possible to discuss this, as it can take a considerable length of time to organise.

Select

Do you need assistance with a Disabled Students' Allowance (DSA) application?

If you select yes, a staff member from Student Support will get in touch.

If you select no, but decide you would like help at a later date, please contact help@leedsconservatoire.ac.uk to arrange support.

Select

International student support information

Students with International fees may be entitled to additional support from their home country, so we would encourage them to contact their home education department for further details. The Skills for Learning service can be accessed for support; more details of which can be found on SPACE.

If any students with International fees have any queries relating to their disability declaration, please contact us on disability@leedsconservatoire.ac.uk.

Health and Wellbeing Support at Leeds Conservatoire

Support for student wellbeing is available for enrolled students during term-time only. The service re-opens when the term resumes for currently enrolled students, but please see the following information for external support mechanisms you can access outside of term-time.

Advice

We offer a non-urgent service during term-time only. Therefore, if you are worried about self-harm or suicidal thoughts and require urgent support, then please consider the following options:

Visit MindWell Leeds for advice and a comprehensive list of local services
Call Samaritans on 116 123
Text 85258 for support from Shout
Call the non-emergency NHS line on 111
Attend A&E at your local hospital, or contact your GP

If you are in crisis, call the Single Point of Access on 0800 183 1485 (open 24 hours, 7 days a week)

If you have injured yourself or taken an overdose, or if you are in danger of hurting yourself or taking your life, call 999 and ask for an ambulance, or attend A&E.

D/deaf students can text 'DEAF' to 85258 for specialist crisis support from SignHealth.

Advice for applicants

We offer a non-urgent service for enrolled students during term-time only. Therefore, if you feel you need urgent support before you enrol at the conservatoire, please consider the following options:

Visit Mindwell Leeds for advice and a comprehensive list of local services
Call Samaritans on 116 123
Text 85258 for support from Shout
Call the non-emergency NHS line on 111
Attend A&E at your local hospital, or contact your GP

If you are in crisis, call the Single Point of Access on 0800 183 1485 (open 24 hours, 7 days a week)

If you have injured yourself or taken an overdose, or if you are in danger of hurting yourself or taking your life, call 999 and ask for an ambulance, or attend A&E.

D/deaf students can text 'DEAF' to 85258 for specialist crisis support from SignHealth.

Do you have any accessibility requirements or appointment preferences?

Select all that apply. If you have no accessibility requirements or appointment preferences, please leave this section blank.

Select

Please give details of your accessibility requirements*

We will try to accommodate these requirements where possible.

Do you consider yourself to belong to any of the following groups?

This is not a mandatory question. However, answers will help us identify students who may require additional support under our Access and Participation initiative. Please select all that apply.

Select

It would also be very helpful if you would let us know which minority ethnic group you identify with.

This is not a compulsory question.

Funding Team

Do you want to ask the Funding Team any questions about your student funding or finances in general?

This question can be left blank if you do not wish to make contact with the Funding Team.

Select

Please ask your question about Funding below

A member of the team will get in touch with you to answer your question, or book you in for an appointment if necessary.

Accommodation Team

Do you want to ask the Accommodation Team any questions about your student living arrangements?

This question can be left blank if you do not wish to make contact with the Accommodation Team.

Select

Please ask your question about Accommodation below

A member of the team will get in touch with you to answer your question, or book you in for an appointment if necessary.

Privacy, Information Sharing & Submission

Please read below, agree to the terms, and submit your referral form.

In order to provide students with support around disability, health and wellbeing, funding and/or accommodation, your information will be generally collected and used in accordance with the Leeds Conservatoire HE Student Privacy Notice. This will include the personal data that you provide to us in the Student Support Referral Form, any subsequent questionnaires and/or notes made by our staff.

Records are used for the purpose of providing support and information will be held securely on secure, Leeds Conservatoire-approved drives for 7 years from the date of your leaving Leeds Conservatoire. The Student Support department also produces anonymised statistical data for the purposes of service analysis and development.

The Disability Support Team and Health and Wellbeing Team use a collaborative approach in order to provide the best quality service to students. At times, it may be necessary for us to share information about your health, disability and/or support needs with other staff in the Conservatoire, these discussions are specific and limited. Furthermore, any relevant declaration(s) or information given in the Disability Support section of this form may be shared with academic and administrative staff to help build Support Plans and enable adjustments to be made.

There may be times when it is appropriate to pass your personal information on to an external agency, for example for a referral to NHS services or to Student Finance in relation to Disabled Student Allowance (DSA). Wherever possible, we will consult with you before doing this. If we have concerns that you are at direct risk, or pose a risk to someone else, we may pass on information without your consent.

Please note, Preferred names and Preferred pronouns given on this form will only be recorded for internal use by the Student Support department. Submitting this form does not constitute a declaration of preferred name and pronouns to the whole conservatoire. For more information on changing your personal details with the conservatoire, follow this link.

By submitting this form, you are explicitly agreeing to the terms and conditions above. Please note that you are entitled to contact us if you have any questions about your data and that this arrangement can be reviewed at any point unless there is an immediate safety issue.

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