Assessment Centre Logo / Information
Lwfans Myfyrwyr Anabl / Disabled Students’
Allowances
Needs Assessment Report
Student’s name
Student’s date of birth
Customer Reference Number
Student Contact Email
Report Reference Number
Assessment centre details
Name:
Tel:
Email:
Needs assessor
Funding body
Assessment information
Date of
assessment
Draft report to
centre
Date of
review
Final report to
student
Report to
funding body
Centre
disclosure
Venue type
MC/
HOC/
OC/
ISR
Page 1 of 14
Venue address
ISR details (If applicable)
Date
requested
Date
authorised
Authorised by
Funding body reference number: [Insert]
Course Information
Higher Education
Provider
Higher Education
Provider address
Course name and
code
Undergraduate
Course type
Start date
Postgraduate
Part Time
(Include
Intensity)
Full
Time
MM / YY
Distance
Learning
End date
Current year of
study
Course language
English / Welsh / Bilingual
FOR ASSESSMENTS CARRIED OUT WITHIN WALES, THIS REPORT IS
AVAILABLE IN THE MEDIUM OF WELSH UPON REQUEST.
Statement of Aims
The remit of this report is to identify the additional expenditure that the student is
obliged to incur in order to attend a designated HE course because of a disability or
Specific Learning Difficulty.
All recommendations made within this report must:
 be in respect of expenditure not covered elsewhere in the Student Support
Regulations; and
 arise from attending or undertaking the course as well as from the disability /
Specific Learning Difficulty
Recommendations must not be made for:
 disability / Specific Learning Difficulty related expenditure which the student
would incur irrespective of whether or not they are a student
 course related costs that any student might incur; or
 expenditure relating to equipment or services which might reasonably be
expected to be provided by the institution under other legislation such as the
Equality Act 2010
Page 2 of 14
Funding body reference number: [Insert]
A.
Background information
A-1
Disability information
A-2
Details of previous DSA assessment/previous support
A-3
Course details
A-4
Higher education provider support / reasonable adjustments
Page 3 of 14
Funding body reference number: [Insert]
B.
Effects of disability and recommendations
B-1
Equipment previously used/currently in use
B-2
Impacts of disability and recommended strategies
B-2-1 - Research and reading
Key impacts
Recommended strategies
B-2-2 - Writing and reviewing academic work
Key impacts
Recommended strategies
B-2-3 - Note-taking in lectures and seminars
Key impacts
Recommended strategies
Page 4 of 14
Funding body reference number: [Insert]
B-2-4 - Managing time and organising work
Key impacts
Recommended strategies
B-2-5 - Access to and use of technology
Key impacts
Recommended strategies
B-2-6 - Practical sessions, placements, field trips and additional course
activities
Key impacts
Recommended strategies
Page 5 of 14
Funding body reference number: [Insert]
B-2-7 – Examinations and timed assessments
Key impacts
Recommended strategies
B-2-8 - Social interaction and communication
Key impacts
Recommended strategies
B-2-9 - Travel and access to higher education environment
Key impacts
Recommended strategies
B-2-10 - Additional information
Key impacts
Page 6 of 14
Funding body reference number: [Insert]
Recommended strategies
Page 7 of 14
Funding body reference number: [Insert]
C.
Summary and costs
C – 1 List of recommended support
Hardware



Software



Non-Medical Helper support



General allowance



Travel allowance



Page 8 of 14
Funding body reference number: [Insert]
C-2 Costs
Equipment allowance
Summary of specialist equipment quotes
Supplier
Quote number
Net cost
Gross cost
£
£
£
£
£
£
Ergonomic / Specialist items quote / reimbursements
Supplier
Quote number
Net cost
Gross cost
£
£
Non-Medical Helpers Allowance (NMH)
NMH role
descriptor
Duration
Assistive technology training
1hr / 2hr / half day
Supplier
Number
of
sessions
Frequency
Hourly rate (net cost)
Hourly rate (gross
cost)
£
£
£
£
£
£
NMH Role
Descriptor
Duration
Supplier
Page 9 of 14
30 mins / 1hr / 2hr
Number
of
sessions
Frequency
Hourly rate (net cost)
Hourly rate (gross
cost)
£
£
£
£
Funding body reference number: [Insert]
NMH Role
Descriptor
Duration
30 mins / 1hr / 2hr
Supplier
Number
of
sessions
Frequency
Hourly rate (net cost)
Hourly rate (gross
cost)
£
£
£
£
Colour sensitivity / Asfedic tuning
Supplier
Net cost
Gross cost
£
£
General allowance
Items
Supplier(s)
Gross cost
£
£
£
Needs Assessment Report
Supplier
Net cost
Gross cost
£
£
Accommodation
Academic year
(
)
Accommodation name
Gross cost
Student’s accommodation
£
Comparative accommodation
£
Difference in cost
£
Travel allowance
Taxi costs
Page 10 of 14
Funding body reference number: [Insert]
Travel between (first line of
address and postcode)
Frequency
Supplier
Supplier
Equivalent public transport
cost
Single /
£
Return / Daily
/ Weekly
Net cost
Gross cost
£
£
Net cost
Gross cost
£
£
Mileage costs
Travel between (postcodes)
Frequency
Single /
Return
Equivalent
public
transport
cost
£
Needs assessor requests/preferred supplier
Specific supplier request
C-3 Summary of costs
Allowance
Total of recommended support (Gross)
Specialist Equipment
£
Non-Medical Helper
£
General
£
Travel
£
Total
Page 11 of 14
£
Funding body reference number: [Insert]
D. Higher education provider support / reasonable
adjustments
D-1
Higher education provider support
D-2
Examinations and assessment
D-3
Other advice and guidance
Page 12 of 14
Funding body reference number: [Insert]
E.
Contact details
Funding body
Name
Phone number
Email
Address
Specialist equipment
Address:
Phone number:
Email:
Address:
Phone number:
Email:
Address:
Phone number:
Email:
Ergonomic equipment
Address:
Phone number:
Email:
Assistive technology training
Address:
Phone number:
Email:
Address:
Phone number:
Email:
Address:
Phone number:
Email:
Non-Medical Help
Address:
Phone number:
Email:
Address:
Phone number:
Email:
Taxi providers
Page 13 of 14
Funding body reference number: [Insert]
Contact name:
Contact role:
Address:
Phone number:
Email:
Contact name:
Contact role:
Address:
Phone number:
Email:
Higher Education Provider
Contact name
Contact role
Phone number
Email
Address
Additional Information
Page 14 of 14
Funding body reference number: [Insert]