/ Dyddiad Geni
/ Eich Enw
/ Eich Cyfeiriad
/ Cwrs
/
Cyfeirnod Cwsmer
/ Côd Post
/ Manylion Personol
Hawlio ad-daliad costau trwy Lwfans Myfyrwyr Anabl (DSA)
ar gyfer blwyddyn academaidd 2021/22
/ Prifysgol neu Goleg
• Costau teithio.
•
Llyfrau Braille.
•
Llun-gopïo.
•
Defnyddiau traul (batris, cetris, papur).
•
Costau ychwanegol llety prifysgol
neu goleg.
Sylwer nad yw hon yn rhestr gyflawn.
Os bydd angen gwybodaeth bellach
arnoch am yr hyn y gallwch hawlio
amdano, a fyddech gystal â ffonio
Canolfan Gyswllt Cyllid Myfyrwyr
Cymru ar 0300 200 4050.
Dylech lenwi’r ffurflen hon er mwyn hawlio unrhyw gostau y bu’n rhaid i chi eu
talu mewn cysylltiad â’ch astudiaethau ac o ganlyniad i reswm sy’n ymwneud â’ch
anabledd, eich cyflwr iechyd meddwl neu anhawster dysgu penodol. Er enghraifft:
SFW/DAEX/2122/A
Claim for reimbursement of costs through Disabled Students’
Allowance (DSA) for the academic year 2021/22
Personal Details
Customer Reference Number
Date of Birth
Name
Address
Postcode
University or College
Course
Complete this form to claim any costs you have had to pay in connection with
your studies due to a reason relating to your disability, mental health condition or
specific learning difficulty. For example:
• Travel costs.
• Books in Braille.
• Photocopying.
• Consumables (batteries, cartridges,
paper).
•
Additional costs of university or
college
accommodation.
Please note that this list is not
exhaustive. If you require further
information on what you are entitled
to claim for, please call the Student
Finance Wales Contact Centre on
0300 200 4050.