Access Solent Registration form
Name:
Date of birth:
Course(s) applied for:
Diagnosis:
Do you have documentation about your diagnosis?
(e.g. diagnostic assessment/ exam arrangements report / doctor’s letter):
Yes / No / Don’t know
Data Protection:
In order to set up and deliver your support, we may need to share information about
your support needs with Solent University staff and relevant external agencies. This may
include funding bodies, support providers, health/diagnostic professionals.
If you are an Apprentice, information about your support needs will be shared with your
employer, as part of setting up support. We will discuss this with you beforehand.
We will share information on a need to know basis. We will contact you if we require
your consent to share information with other parties.
Please record your consent to us sharing your data on this basis. Refusal to consent to
information sharing will limit our ability to meet your individual needs.
Information about your support needs will be stored confidentially on a Student Services
administrative system. Please ask for more information about this if needed.
I consent to Access Solent sharing my information as described above.
If you also wish Access Solent to discuss your support needs with someone else (e.g.
parent, spouse, carer), please tick the box below and let us know who they are.
I consent to Access Solent sharing information about my support needs with the
following contact/s:
Name of contact/s:……………………………………………………………………………………………..
Further information about Southampton Solent’s Data Protection Policy can be found
at: www.solent.ac.uk/about-us/the-university/data-protection-foi.aspx
Signed: ………………………………………………………… Date: …………………………………………
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