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Student Support Unit
Your support needs
Register and Submit Medical Evidence
Homepage
Before you come
Your support needs
Booking a DSA needs assessment
Useful Resources During the Covid-19 Lockdown
External Resources For Disabled Students
Register and Submit Medical Evidence
Access
Study support
Funding
Useful forms
Meet the team
DSA needs assessors
NMH providers
Information for staff
Common questions
Student Support Unit
Register and Submit Medical Evidence
<h3 class="wcmform-title">SSU Consent Form</h3> <p class="wcmform-description">In order to provide advice and to put reasonable adjustments and other support arrangements in place, students need to share personal data with the Student Support Unit. This personal data may also need to be shared with others at the University and to external parties, including medical evidence and information about support needs. In such cases, disclosure is only made with your consent. Please note that if you do not wish to consent to disclosure then, in some cases, the Student Support Unit may not be able to put support arrangements in place.<br /> <br /> • If you require information regarding medical evidence, advice can be found under Your Support Needs on our website. You can still submit the consent form by uploading a self-declaration outlining your difficulties, an Advisor will then be in touch to provide support with obtaining evidence.<br /> <br /> • If you have already supplied us with your medical evidence or Needs Assessment Report and we have requested consent, please upload a self-declaration confirming we have your evidence so the form can be submitted.<br /> <br /> • If you are seeking an assessment for a Specific Learning Difference or ADHD, please complete the screening questionnaire you will find under Useful Forms on our website and upload before submitting consent.<br /> <br /> Please only submit the form ONCE - we will contact you if we need additional information.<br /> <br /> Occasionally the form will not submit correctly if there is high traffic - if you receive an error please try again.</p> <form class="style1 wcmform" action="" method="post" id="f26B4DC69-1631-D5CD-F2F1-DFADE3FBFFFA" enctype="multipart/form-data"> <input type="hidden" name="csrf_token" value="MTYzNDgwNTg0M2IyMzVmYjc3MzdlZjA4Yzc1NjFmYWQ5NDFjOWMwNjdjZTRlMjI5MGU3MGUzOWNlOTM1OWUzZjFlMmQ0YmRmNDBjN2RiNTFjMmY3NDQwN2Vj" /> <input type="hidden" name="form" value="26B4DC69-1631-D5CD-F2F1-DFADE3FBFFFA" /> <fieldset data-id="fs-0"><legend class="legend show-for-sr">Personal Information</legend><h3 aria-hidden="true">Personal Information</h3><dl><dt><label class="required" for="ZcqnbU7UpY">Last Name</label></dt><dd><input type="text" name="ZcqnbU7UpY" id="ZcqnbU7UpY" required="required" /></dd><dt><label class="required" for="Bvgl7Uxy6i">First Name</label></dt><dd><input type="text" name="Bvgl7Uxy6i" id="Bvgl7Uxy6i" required="required" /></dd><dt><label class="required" for="6TILsZx4lv">Pronouns</label></dt><dd><input type="text" name="6TILsZx4lv" id="6TILsZx4lv" required="required" /></dd><dt><label class="required" for="4ITYlNN6Yu">Registration Number</label></dt><dd><div class="description">This can be found on your student ID card.</div><input type="text" name="4ITYlNN6Yu" id="4ITYlNN6Yu" required="required" /></dd><dt><label class="required" for="pYGV9aQnfl">Email</label></dt><dd><input type="email" name="pYGV9aQnfl" id="pYGV9aQnfl" required="required" /></dd><dt><label class="required" for="p4Klmgnx6d">Date of Birth</label></dt><dd><div class="elementGroupContainer elementDate"><input type="date" name="p4Klmgnx6d" id="p4Klmgnx6d" min="" max="" data-ui="date" required="required" /></div></dd><dt><label class="required" for="YOl2160db6">Telephone Number</label></dt><dd><input type="number" name="YOl2160db6" id="YOl2160db6" required="required" value="" /></dd><dt><label class="required" for="yusTLMBj1h">Course Title</label></dt><dd><input type="text" name="yusTLMBj1h" id="yusTLMBj1h" required="required" /></dd><dt><label class="required" for="LMl3wKwhka">Year of Study</label></dt><dd><select name="LMl3wKwhka" id="LMl3wKwhka" required="required"><option value="">Please select...</option><option value="1">1</option><option value="2">2</option><option value="3">3</option><option value="4">4</option><option value="5+">5+</option></select></dd><dt><label class="required" for="IuU0qjrb34">Status</label></dt><dd><select name="IuU0qjrb34" id="IuU0qjrb34" required="required"><option value="">Please select...</option><option value="UG">UG</option><option value="PGT">PGT</option><option value="PGR">PGR</option></select></dd><dt><label class="required">Disability Type</label></dt><dd><div class="elementGroupContainer elementCheckbox"><label><input name="whZfxxvBHw[]" type="checkbox" value="Specific Learning Difference" /> Specific Learning Difference</label><br /><label><input name="whZfxxvBHw[]" type="checkbox" value="Disability or on-going physical health condition" /> Disability or on-going physical health condition</label><br /><label><input name="whZfxxvBHw[]" type="checkbox" value="Mental Health condition" /> Mental Health condition</label><br /><label><input name="whZfxxvBHw[]" type="checkbox" value="Autism Spectrum Condition" /> Autism Spectrum Condition</label><br /></div></dd><dt><label class="required" for="MTgwrwHQlL">Further Information</label></dt><dd><div class="description">Please explain the impact of your condition on your studies and what other reasonable adjustments you may require such as; physical access, library support, emergency evacuation assistance, computer in exams, etc.</div><textarea name="MTgwrwHQlL" id="MTgwrwHQlL" required="required" style="width:98%;height:10em;" class="elementTextarea"></textarea></dd><dt><label class="required" for="dbsxQFHCdI">Medical Evidence</label></dt><dd><div class="description">No support can be put in place unless acceptable evidence has been supplied to the Student Support Unit. Please ensure all documents are labelled correctly with your full name before uploading (ex LASTNAME firstname Medical Evidence 1, etc). For information see this page: https://www.sussex.ac.uk/studentsupport/support-needs</div><div class="elementGroupContainer elementFile"><input type="file" name="dbsxQFHCdI[0]" id="dbsxQFHCdI0" required="required" accept=".doc,.docx,.odt,.pdf,.rtf,.txt,.html,.jpg,.jpeg,.png,.bmp,.tif,.tiff,.gif" data-filesize="5242880" /></div><i class="suffix">Maximum of 5MB<br/>Only files of type doc, docx, odt, pdf, rtf, txt, html, jpg, jpeg, png, bmp, tif, tiff, and gif are allowed</i></dd><dt><label class="" for="AGenbV7naO">Additional Medical Evidence</label></dt><dd><div class="description">Space for an additional piece of medical evidence, not required to submit the form.</div><div class="elementGroupContainer elementFile"><input type="file" name="AGenbV7naO[0]" id="AGenbV7naO0" data-filesize="5242880" /></div><i class="suffix">Maximum of 5MB</i></dd><dt><label class="required">Consent</label></dt><dd><div class="description">In order to provide advice and to put reasonable adjustments and other support arrangements in place, students need to share personal data with the Student Support Unit. This personal data may also need to be shared with others at the University and to external parties, including medical evidence and information about support needs. In such cases, disclosure is only made with your consent. <br /> Please note that if you do not wish to consent to disclosure then, in some cases, the Student Support Unit may not be able to put support arrangements in place. <br /> This information is stored securely and will only be used for the purpose of supporting you or for anonymous statistical purposes.<br /> -------------------------------------------------------------------------------------------------------------------------------------<br /> I give my consent to my personal data being disclosed to the following, for the purpose of assessing my support needs, providing advice and / or putting support arrangements in place.<br /> <br /> I understand that I can revisit my consent choices and can withdraw my consent at any time.</div><div class="elementGroupContainer elementCheckbox"><label><input name="XtfOW4CLN3[]" type="checkbox" value="Student Systems and Records Office or Research Student Administration Office (e.g. in relation to adjustments to assessment arrangements) Needed for standard reasonable adjustments." /> Student Systems and Records Office or Research Student Administration Office (e.g. in relation to adjustments to assessment arrangements) Needed for standard reasonable adjustments.</label><br /><label><input name="XtfOW4CLN3[]" type="checkbox" value="Relevant individuals within my School such as the Director of Student Experience, Academic Advisor, those teaching me (e.g. in relation to adjustments to my teaching and assessment, emergency evacuation assistance). Needed for standard reasonable adjustments." /> Relevant individuals within my School such as the Director of Student Experience, Academic Advisor, those teaching me (e.g. in relation to adjustments to my teaching and assessment, emergency evacuation assistance). Needed for standard reasonable adjustments.</label><br /><label><input name="XtfOW4CLN3[]" type="checkbox" value="For Students with communicable diseases (e.g. Cystic Fibrosis): Relevant individuals within Room bookings and across all schools, in relation to adjustments to my timetabling" /> For Students with communicable diseases (e.g. Cystic Fibrosis): Relevant individuals within Room bookings and across all schools, in relation to adjustments to my timetabling</label><br /><label><input name="XtfOW4CLN3[]" type="checkbox" value="Library staff (e.g. in relation to library support such as book collection)" /> Library staff (e.g. in relation to library support such as book collection)</label><br /><label><input name="XtfOW4CLN3[]" type="checkbox" value="Housing Office & Residential Services (e.g. in relation to student accommodation)" /> Housing Office & Residential Services (e.g. in relation to student accommodation)</label><br /><label><input name="XtfOW4CLN3[]" type="checkbox" value="Other services within the Directorate for Student Experience. (Counselling, Wellbeing, Student Life Centre, etc.)" /> Other services within the Directorate for Student Experience. (Counselling, Wellbeing, Student Life Centre, etc.)</label><br /><label><input name="XtfOW4CLN3[]" type="checkbox" value="My GP or other healthcare providers (e.g. in relation to medical evidence)" /> My GP or other healthcare providers (e.g. in relation to medical evidence)</label><br /><label><input name="XtfOW4CLN3[]" type="checkbox" value="Educational Psychologist (e.g. in order to assess support needs)" /> Educational Psychologist (e.g. in order to assess support needs)</label><br /><label><input name="XtfOW4CLN3[]" type="checkbox" value="Sussex Estates and Facilities (e.g. in relation to accessibility of buildings, parking)" /> Sussex Estates and Facilities (e.g. in relation to accessibility of buildings, parking)</label><br /><label><input name="XtfOW4CLN3[]" type="checkbox" value="Others such as support workers, note-takers and readers." /> Others such as support workers, note-takers and readers.</label><br /></div></dd><dt><label class="required" for="nVwrE2tG2k">GP Address</label></dt><dd><input type="text" name="nVwrE2tG2k" id="nVwrE2tG2k" required="required" /></dd><dt><label class="required">Submit and Confirm</label></dt><dd><div class="description">By clicking submit I consent to share my information with the agreed parties as selected above.</div><div class="elementGroupContainer elementCheckbox"><label><input name="1abKN92Kbp[]" type="checkbox" value="I agree" /> I agree</label><br /></div></dd></dl></fieldset> <input class="button" type="submit" value="Submit" /> </form> <script type="text/javascript"> $(function(){ function bytesToSize(bytes) { var sizes = [' bytes', 'KB', 'MB', 'GB', 'TB']; 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