I conrm that the information given on this form is true, complete and accurate and that none of the information requested or other material
information has been omitted. I accept that if it is discovered that I have supplied false, inaccurate or misleading information, Birmingham City
University reserves the right to cancel my application, withdraw its offer of a place or terminate attendance at the University and I shall have no
claim against Birmingham City University in relation thereto.
PLEASE INDICATE HOW YOU HEARD ABOUT THE COURSE (please tick relevant boxes):
Birmingham City University Course Enquiries Team
Personal enquiry to Birmingham City University
Birmingham City University website
Other (please specify):
Do you have any special needs? (please tick). The information you provide will be treated condentially and will not affect judgements concerning your
academic suitability for a course.
You have a social/communication impairment such as Asperger’s syndrome/other autistic spectrum disorder.
You are blind or have a serious visual impairment uncorrected by glasses.
You are deaf or have a serious hearing impairment.
You have a long standing illness or health condition such as cancer, HIV, diabetes, chronic heart disease, or epilepsy.
You have a mental health condition, such as depression, schizophrenia or anxiety disorder.
You have a specic learning difculty such as dyslexia, dyspraxia or AD(H)D.
You have a physical impairment or mobility issues, such as difculty using your arms or using a wheelchair or crutches.
You have a disability, impairment or medical condition that is not listed above.
You have two or more impairments and/or disabling medical conditions.