Postgraduate Form

Questionnaire to Determine Support Requirements 2019/20

1. Personal Details

Please enter your details

2. Course Details

Names of postgraduate courses applied for at Queen's. Please list all courses for which you have submitted an application, even if you have not received an offer.

3. Disability Support Requirements

Part a)

Nature of Disability

Part b)

Please provide as much detailed information as possible about your disability and how it impacts on your studies.

Part c)

Please outline what educational support arrangements have been made for you to date.

4. Specific Requirements whilst at University

What specific support do you envisage you may have whilst studying at Queen’s? You will be invited to discuss your support requirements in greater detail if you are successful in obtaining a place at Queen's.

5. Support during placement, field work, laboratory work and similar environments

Part a)

Some courses may include placements, field work or a requirement to work within a laboratory setting. Please indicate if you have any additional support requirements within these settings as a result of your disability/medical condition.:

Support requirements for study, eg notetaker, materials in alternative format etc.

Part b)

Do you envisage that you will require on-campus accommodation?

If you have answered YES to this question, please indicate any disability-related requirement below.

If Other Please specify

Please note that answering YES to part 5b does not constitute an application for University accommodation. For information about accommodation, please contact the Elms Village:

Telephone: 028 9097 4525

The University Disability Services will ensure that personal data contained in this form will be used to plan appropriate support for you. It may be necessary for Disability Services to disclose appropriate and relevant details to other University departments to facilitate this process.

I consent to information relating to my personal details, nature of disability and academic and support requirements being forwarded as outlined above.

Please type your name below and insert the date if you agree with the disclosure of this information on these conditions.

If you have any difficulties in this regard, please contact Disability Services for advice.