Support and Adjustment Form

Please Read: This form is intended for students (and teaching staff) to request adjustments for the first time. When completing this form please be sure to be as specific and detailed as possible and include any information that you think is important for the staff to know.

Important: If there are already adjustments in place, please make a supplemental adjustment request in the AccessBeckett student portal. (Log in)

* indicates a required field

Student Details

Things to remember when completing this form

  • This form contains different types of questions, including text boxes, Yes/No questions, and multiple-choice questions.

  • Please read each question carefully and provide as much information as you can. If you are unsure about a question, or would prefer not to answer it, you can skip it and continue with the form.

  • The only mandatory questions are your personal details, whether you are a member of staff, and details of your disability if you are requesting this type of support.

  • Every submission is reviewed by a member of our team. If we need any additional information, we will contact you to discuss this with you.

  • For some multiple-choice questions, you can select more than one option. To add multiple selections, use the "Add..." button.

Please use your university issued email address

Who is completing the form?

Are you a member of Leeds Beckett staff?Required

What type of support or adjustments do you need?

Disability, sensory loss, long term health condition, or learning difference support

A disability is a physical or mental health condition that has a long-term and substantial impact on everyday activities (usually lasting 12 months or more). This includes long-term health conditions, physical or mobility conditions, sensory impairments, mental health conditions, specific learning differences such as dyslexia, and neurodivergent conditions such as autism or ADHD.

Pregnancy related support

This refers to support for students who are pregnant, have recently given birth, are experiencing pregnancy-related health needs, undergoing fertility treatment, or affected by related circumstances such as baby loss or a partner’s pregnancy. This includes situations where study activities, including practical learning or work-based placements, may need to be adjusted for health, safety or accessibility reasons.

Short term illness or injury support
This may include a short term illness expected to last no longer than six months, or an injury such as a broken bone or muscle strain. The illness or injury must affect your ability to access and take part in your studies.

Standards of Inclusive Practice

Have you read the Standards of Inclusive Practice?

Disability Declaration

Note: If you have selected disability related support needs above, you can make a declaration here. If you have selected other support needs, such as pregancy or short term illness/injury support, please move onto the next section (Your Study Challenges). 

Your study challenges

Examples could include getting around, managing your personal needs, or how it impacts you academically.

You can also list any adjustments you have received previously during your education.

Previous Exams, Assessment, and One-to-One Support

Have you received one-to-one support in the past?
Have you received exam support in the past?

Access Requirements

Do you have any access requirements?

Health and Safety

Would you have difficulty safely evacuating the room/building during an emergency?

Upload Evidence

IMPORTANT: Although we do not require evidence to provide reasonable adjustments, it can help us to better understand your needs and put suitable adjustments in place within your plan.

Drop files here to upload

Data Sharing

Do you consent to your Support and Adjustment Request being processed?Required

Where consent is provided, the information submitted will be used to create a student support record to enable the University to coordinate and deliver appropriate support. This record will hold the details you provide in this form, together with information relating to agreed support requirements.

The information will be accessible to relevant University staff involved in supporting your teaching, learning and assessment, where this is necessary for the purpose of implementing and managing support. Information will be handled in accordance with Leeds Beckett University’s privacy notice and applicable data protection legislation.

For further information about how your data is used and your rights, please refer to the Leeds Beckett University Privacy Notice:
Leeds Beckett University Privacy Notice