DSA
Claim for reimbursement of costs
through Disabled Students’ Allowance
2021/22
Personal Details
Customer Reference Number
Date of birth (DDMMYYYY)
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.
• Consumables (batteries, cartridges, paper).
• Additional costs of university or college accommodation.
Please note that the above list is not exhaustive. If you require further information
on what you are entitled to claim for, please contact us on 0300 100 0607.
To find out how we’ll use the information you provide go to
www.gov.uk/studentfinance to read our Privacy Notice before completing this
form.
Alternatively, you can request a copy by writing to the Student Loans Company
(SLC) at 100 Bothwell Street, Glasgow, G2 7JD or by calling us on 0300 100 0607.
If we become aware of fraudulent activity we will share the supplier details you
give us with Cifas.
You need to tell your suppliers that you’ve given us their details.
SFE/DAEX/2122/A
