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Initial Query: Student Wellbeing Form

Queen's University Belfast is committed to supporting all students throughout their time at Queen's. A wide range of support services are available to all students, which offer information, advice, and specialist services both internal and external to the University. We encourage students to engage with support services, to ask for assistance, and to consider their options and prevent, alleviate or resolve difficulties as they arise.

We know that confidentiality is important, and the University is committed to creating an environment where students are comfortable in seeking support.  Please ensure you read our Student Support Agreement in advance on completing the form below. There will be an opportunity to discuss this at your first appointment, should you have any queries. Student Wellbeing Service will hold and process your data in line with the University’s Student Privacy Notice so please also familarise yourself with this. 

If you are residing outside of Northern Ireland (NI), please note the delivery of our services will be undertaken in accordance with the laws and regulation standards in NI, and any disputes will be subject to NI law.

If you have a wellbeing issue or concern, please complete the form below and a member of the team will be in touch. If you have been affected by either sexual misconduct, bullying, harrassment or hate crime, you can complete the Report and Support online reporting tool and receive support from, specially trained staff. 

If you are a member of staff concerned about the Wellbeing of a student, please contact us using our staff online form.

SWS Form: Initial Query: Student Wellbeing Form

Section A: Student Details

Section B

Please provide details of an EMERGENCY CONTACT:

Section C


Please tick the box below to indicate that you agree to participate with support from Disability and Wellbeing Services, and the sharing of information stated in our Student Support Agreement.

Please Agree with the Student Support Agreement before submitting.

Please note: You have the right to withdraw your consent to disclose information at any time. You can do this be informing us in writing to Upon receipt of this request, a relevant staff member will make contact with you to discuss this further.

Section D

It would help us to have some background information about your specific issue or concern, so if you decide to attend a meeting with us, we can collate relevant support information for your session. Please tick the box(s) below to provide us with some information relevant to your circumstances. (more than one can be ticked)

You have checked an invalid number of boxes.

Section E

Staff at Student Wellbeing are committed to ensuring urgent cases are dealt with promptly. On a scale of 1 to 10 please rate how anxious, worried or concerned you feel by your specific issue or concern. (10 being very anxious, worried or concerned)

We take all requests for support very seriously and we endeavour to get back to students as soon as possible.

Student Wellbeing Service is available Monday to Friday, 9am -5pm and therefore the email account and forms are monitored during this period. The Service closes on recognised public holidays and University Closure Days.

The Following supports are available 24 hours, 365 days per year.

- Inspire Student Counselling: Freephone telephone service on 0808 800 0016 or email:
- Samaritans: 116 123 or Lifeline: 0808 808 8000
- 24 Hr Domestic & Sexual Violence Helpline: 0808 802 1414