Online Profile Form

About you and your course

Personal Details

Please enter your name
Please enter your address
Please enter your postcode
Please enter your email address

About you and your course

Course Details

Will you be attending the University full-time or part-time?
Does the course that you are applying for have placements and/or field trips?
Are you a blue badge holder?

About your disability

Dsylexia or other SpLD

Are you dyslexic or have any other Specific Learning Difficulty (SpLD) such as Attention Deficit Disorder, Attention Deficit Hyperactivity Distory, Dyscalculia or Dysgraphia?
Please choose Yes or No

About your disability

Autism or Aspergers Syndrome

Do you have Autism or Asperger Syndrome?
Please choose Yes or No

About your disability

Mental Health difficulties

Do you have a Mental Health difficulty?
Please choose Yes or No

About your disability

Visual Impairment

Do you have any visual impairment?
Please choose Yes or No

About your disability

Hearing Loss

Do you have any loss of hearing?
Please choose Yes or No

About your disability

Long-term health conditions or other disabilities

Do you have a long-term health condition or other disability not already covered here?
Please choose Yes or No

Getting the right support

Accommodation Support

Will you be living at home?
Please choose Yes or No

Getting the right support

Study Support

Have you had study-related support in the past?
Have you had extra time for exams before?
Have you had support at school or college from a teaching assistant or a specialist tutor?

Do you think you will require any of the following support at university?

Mentor / Dyslexia Support Tutor *
A computer with specialist software*
Orientation (finding your way around) *
A note taker (this is someone to take notes for you in lectures) *
Mobility assistance *
Extra time for exams and assignments
A personal recording device so that you can record lectures (if suitable) *

* Please apply for Disabled Students’ Allowances as this is the funding available for the support requirements you may have. Please note that International/EU students are not eligible for Disabled Students' Allowances. If you are an International/EU applicant you should contact our Disability Support Team early in the application process so that we may investigate possible sources of funding.

Disabled Students’ Allowances (DSAs) For further information and to download an application form go to For applicants or students who will have an have an NHS bursary go to

Have you applied for the Disabled Students’ Allowances (DSAs)?

Getting the right support

Personal Support

Do you think you may require assistance with any of the following because of your disability or medical condition? Please check the below items where appropriate.

This support cannot be funded via DSAs. Please apply to your local Social Services department as soon as possible to advise them of the support you require.

Last step

Your Consent

Important: Please complete this consent form to give permission for the Disability Support staff at Birmingham City University to liaise and share information with people or organisations on your behalf, in order to ensure they are aware of any specific requirements you may have relating to a disability or medical condition.

Data Protection Statement

Disability Support (Student Services) at Birmingham City University collects and holds information, both paper based and electronically, about you and your disability. This information is deemed to be sensitive personal data and is only used to advise you about support that may be available to you. In some cases the information may be passed to third parties, including relevant University staff and organisations directly involved in the assessment of students’ requirements and in the awarding of funds for students with disabilities. Exceptions may arise where the service has a legal obligation to share information, e.g. if there is significant concern about a serious risk to your own health and wellbeing or to that of a third party.

Please indicate you have read the Data Protection statement and now proceed to the consent form, which will tell us with whom you are happy for us to share information about you, when we are arranging your support.

Please select consent box
I would like to receive information from Birmingham City University about support for my disability, Specific Learning Difficulty or mental health difficulty via:

Please indicate the people and organisations that the Disability Support staff may share information with on your behalf

N.B. This may be your Local Authority, Student Finance England, the NHS or (in the case of military students) the military. Copies of your medical evidence will be provided to your funding body. Concerns about this should be discussed with your adviser.

Birmingham City University is committed to safeguarding your personal data. Whenever you provide such information we are legally obliged to use your information in line with all applicable laws concerning the protection of personal information including the General Data Protection Regulation 2018.

View a full copy of our privacy policy

Contacting us about how we use your information

If you have any questions, comments or concerns about how we use or handle your information please contact the Data Protection Officer at: Data Protection Officer, Information Management Team, Birmingham City University, University House, 15 Bartholomew Row, Birmingham B5 5JU, email

If you are not content with how we handle your information please contact our Data Protection Officer. However you do also have the right to complain to the Information Commissioner at: Information Commissioner’s Office, Wycliffe House, Water Lane, Wilmslow, Cheshire, SK9 5AF. Information about the Information Commissioner.