Personal needs form for living in Student Residences
General information
Please complete all sections of the form. If you have no special requirements or if any sections
of the form are not relevant to your requirements it can be marked as not applicable.
If you do not require allocation in a specific location or adaptations to the accommodation, you
do not need to complete or return the form.
In all sections if you have additional information please feel free to attach additional sheets.
The information provided will only be shared with staff members within the University who are
directly involved in the allocation of your accommodation and provision of any adaptations or
additional equipment allocated for your use. The more information you can provide the better
able we are to allocate a room suitable for your requirements.
Student name:
Emergency contact:
Contact email and telephone number:
Please state all medical conditions and/or disabilities that may affect your stay in student
If you have already visited the Residences and identified with an OT or the Residence Manager a
suitable room or residence, please provide the details of that room and the contact person with
whom you met at the University.
In relation to the above please advise as fully as possible on this form what special adaptations
or requirements you need to be able to reside in any accommodation offered by Solent
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Residences personal needs form
November 2018
Mobility requirements
In the study bedroom that is allocated for your use can you advise what, if any adaptations are
required and what equipment you will be bringing with you?
Are you a wheelchair user or a user of mobility aids such as motorised scooters?
If yes, please advise what equipment you use
Will you require a charging zone for your wheelchair or mobility aid? Yes/No
Do you require a hoist in your room to assist with transferring? Yes/No
Would you benefit from being allocated a room in one the
residences closest to the main campus? Yes/No
What adaptations, if any, do you require for the kitchen?
What adaptations, if any, do you require for the bathroom?
If you are not a wheelchair user but have mobility needs would you
benefit from being allocated a room on a lower level floor? Yes/No
What is the highest floor level you would be comfortable with?
Do you require additional space in the room for storing medical
equipment or mobility aids? Yes/No
If yes, please advise what this equipment is
All rooms are provided with a standard 3 foot bed and medium support mattress. If you are
intending to bring your own bed, mattress or any other furniture you require for your daily living
needs please advise us so that the relevant furniture can be removed ahead of your arrival.
What items will you be bringing /supplying yourself?
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Residences personal needs form
November 2018
Personal assistance
The residence staff are on hand to provide support and assistance wherever possible, however
they are not able to provide personal care or one to one support for activities such as cooking,
shopping etc.
Will you require a live in carer or personal assistant? Yes/No
Please note that the fees for the additional carer’s room must be covered by the applicant. The
University Accommodation Team is not able to offer financial support in this regard.
Will you be arranging a care package with your local
Social Services Adult Care Team? Yes/No
If yes, how many care hours per week are you expecting?
Auditory and visual requirements
Do you have a visual impairment? Yes/No
Will you be bringing any additional equipment with you Yes/No
If yes, please provide a description
Will you have an assistance dog? Yes/No
Do you have impaired hearing? Yes/No
Will you be able to hear the fire alarm at night? Yes/No
Will you be able to hear the fire alarm when using the shower? Yes/No
We can provide the following specialised equipment for residents with a hearing impairment,
please indicate which piece(s) of equipment you would require:
Vibrating Pillow alerts the user to a fire alarm sounding
(cannot be used as an alarm clock) Yes/No
Visual Fire Alarm Yes/No
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Residences personal needs form
November 2018
Height requirements
Rooms can be adapted for taller or shorter occupants. A site visit is required to establish what
adaptions if any are required. Please indicate if you would like to arrange a site visit for this
I would/would not* like to arrange a site visit
*Please delete as appropriate
Unseen disabilities
If you have an unseen disability (for example: diabetes or epilepsy)
Will you require additional equipment or adaptations to
any room allocated to you? Yes/No
Please provide full details of the equipment/adaptation. Please note: if your equipment
requires an external phone line, this will not be possible to accommodate in student residences.
Medical fridges can be provided for your use in your bedroom, please indicate if you require a
fridge or if you intend to provide one yourself.
Mental health, psychological and behavioural conditions
You may not have any requirements or requests in terms of equipment and adaptation to the
study bedroom. If you have any requirements in terms of location, flat or kitchen group size or a
requirement for a quieter area that would assist with your transition to communal living then
please advise the Accommodation Team
Gender identity and transitioning
If you have any requirements that you believe the Accommodation or Residence Team may be
able to assist with then please advise us of those either on this form or by separate email or
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Residences personal needs form
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Medicines and medical supplies
All medications kept on site must be prescribed by a medical practitioner
Please advise what medication and medical supplies including epi pens, feeding tubes, bandages
etc. will be stored at the Residence in your room.
The Residences team is not able to administer any medicines to students and it is the student’s
responsibility to ensure that all medicines are secured in their locked bedroom at all times.
If you require a sharps bin you must arrange this with your own doctor and they will advise you
on how to arrange delivery and collection as and when required.
If you will be using any other medical equipment such as feeding tubes, bandages or anything
that could be described as producing medical waste please consult your doctor as to how this
should be disposed of and what arrangements need to be in place to facilitate this ahead of your
arrival at residences.
If you have medical information that could affect your stay in Student Residences which has
not been covered in the above sections, please provide information on a separate sheet.
The date this form is received will determine whether requested equipment to meet your needs
will be available upon arrival at the Student Residences so please reply early. If you have an
acute disability that requires adaptations or equipment provision you may be asked to arrange
an Occupational Therapist assessment and provide supporting medical evidence.
If you wish to discuss any of this further please contact The Accommodation Office on
023 8201 5040 or email
You can scan and email this form to or post this form back to the
Accommodation Office, at Accommodation Office, Southampton Solent University, East Park
Terrace, Southampton, Hampshire, SO14 0RN
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Residences personal needs form
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