NON-SPECIALIST HUMAN SUPPORT REVIEW

Student Number:  
Surname:  
Forenames:  
Telephone Number:  
Email address:  

Non-Specialist Human Support Currently Agreed with DDS (if any)

Non-Specialist Human Support Requested by Student

Please give reasons for requested arrangements (please provide as much detail as you can – you may continue on another sheet, if necessary)

By signing this form you are agreeing that the Disability and Dyslexia Service can share this information with colleagues in the Appeals, Complaints and Conduct unit. 

Student Signature: 							Date: