Student Support Registration Form

Student Support Registration Form

Thank you for choosing FCS to be your support provider. For us to assign you a support worker most suited to your needs, please provide us with the details requested below.

Although we usually assign support immediately, we have a ten working day policy whereby we aim to have support engaged within this time.

If you have any questions, please email support@firstclass-support.co.uk or call 01752 358641.

* Family Name

* First Name

Address

Town/City

Post Code

Phone

* Mobile

Academic Email Address

* Personal Email Address

Date of Birth

CRN (SLC Customer Reference Number)

* Course type

* Degree level

* Course of Study

* Institution Name

Campus/Location Support is Required

* Enrolment Month-Year

* Estimated Graduation Month-Year

Nature of Disability

Type of Support

Hours of Support Awarded

* Are you completing this form on behalf of someone else? Yes No

* Do you wish for someone else to discuss your support needs with us? Yes No

* Full Name

* Contact Details

* Relationship/Capacity Known

* Does your course include a placement or year abroad? Yes No

* DSA/ATW or other funding body letter

Needs Assessment Report