Cardiff Metropolitan University Assessment Centre Pre Assessment Questionnaire
Please send this questionnaire to Cardiff Metropolitan University Assessment Centre at least 5 days prior to your assessment.
Full Name______
Home Address ______
______Post Code______
Term Address ______
______Post Code ______
Home Tel ______Mobile ______
Email Address ______
Date of Birth______
Name of your Funding Body______
Name of University or College where you are/will be studying:
Full title of Course______
Length of course (in years) _____ Which year are/will you be in? _____
Please tick the box below that applies to your course
Undergraduate Part time Undergraduate Full time
Postgraduate taught full time Postgraduate taught part time
Postgraduate research full time Postgraduate research part time
“Top up”
How did you find out about our Centre? ______
Information on your disability and how it affects your learning
How would you describe your disability or medical condition and how it affects you?
______
______
Describe how your disability affects your ability to study
______
Your Previous Examination Arrangements
Which of the following arrangements have you had for exams? (Please tick all that apply)
Extra time Rest Breaks
Scribe Use of Technology
Reader Alternative format papers
Separate Room
Other (give details)______
Methods of Producing Coursework
What is your usual method of producing written work?
Handwriting Word Processing Scribe
Voice Recognition Software Other ______
Do you use a communication system (speech aid) Yes No
Other: If Yes please give name of system ______
If you have a hearing impairment, what is your preferred communication e.g. British Sign Language/ lip reading: ______
Do you use any sound enhancing technology? Yes No
Technology Used
Do you use any other aids or technology to assist you with your studies?
Yes No
If yes, Please give full details: ______
Do you currently use any specialist software? Yes No
If yes, please give full details: ______
Your Course
We require information on how your course is delivered.
Tick all the following that apply:
Lectures Computer Labs
Tutorials Science Labs
Seminars Placement
Group Work Field Trips
Please give details of any other learning situations on your course e.g. summer schools, distance learning.
Please send to:
Cardiff Metropolitan University
Disability Service
The Student Centre Telephone: 02920 416170
Western Avenue Fax: 02920 416950
Cardiff CF5 2YB Email: