Consent to Pass on Information

Learner DevelopmentService

Information about disability is classed as ‘sensitive personal’ data and will be processed by the University in accordance with the Data Protection Act 1998 and the University’s Data Protection Policy.

The University has a duty under the Disability Discrimination Act 1995 to make “reasonable adjustments” for disabled students. In order to make these adjustments, some information regarding your disability may have to be disclosed to relevant members of staff in the University such as administrators, tutors, technicians, librarians, and toorganisations/ individuals outside the university such as exam boards, funding bodies, Assessment Centres, external placement providers as well as both MMU and private halls of residence. Detailed information about the nature of an individual’s impairment or medical information will not be passed on unless it is relevant to making reasonable adjustments.

Your consent to information regarding your disability being disclosed will be valid until the completion of your academic studies at MMU. However, you may withdraw your consent at any time by contacting the Learner DevelopmentService.

You can request that no information about your disability is passed on to others. However,you should be aware that if you do this it may restrict/ adversely affect the level of support the university or placement provider can offer you and could limit the types of adjustments which can be put in place.

Also, you should be aware that even if you have asked for information about your disability not to be passed on to any other members of staff, there could be certain instances where this may still have to be done for reasons of health and safety or emergency.

Learner Developmentmay occasionally make you aware of disability-related activities or opportunities linked to MMU that may be of interest to you, if you would prefer not to receive this information please speak to a member of staff at Learner Development.

Any medical evidence submitted by you will remain on our records. All evidence will be securely destroyed 3 years after you complete your programme, in line with the University’s record management framework.

If you would like to informally discuss the likely consequences of disclosing or

withholding information, please speak to a Learner Development Adviser.

Please contact the Learner DevelopmentService immediately if there is a change in the circumstances concerning your disability which you feel the university should be aware of.

Disclosure of Disability

Name:______

Date of Birth: ______Tel (Mobile): ______

Course:______

Full Time / Part Time (please circle)Undergrad / Postgrad (please circle)

MMU Registration Number or UCAS Number:______

Disability:______

Disabled Students’ Allowances(DSAs)

I would like to apply for funding and therefore consent to information being passed to my funding body and assessment centre (Please Circle):

Yes No

Funding body: ______Home Postcode______

I have read and understood the information on the back of this form relating to disclosure of information about my disability. I consent to MMU keeping information about my disability in electronic format and on paper. I also consent to data regarding my disability, as described overleaf, to be passed on:

Student Signature: …………………………………………. Date……………….

How did you first hear about Learner Development?

Leaflet/Poster / Stand / Website / Tutor
Friend / College / Student Support Officer / Email

Other, please specify______

Care Leavers

Are you a care leaver who has spent at least 3 months in care? Yes No

Please enclose a copy of a current medical letter or a report from an educational psychologist(please do not send your original copy) and return this form to:

Learner DevelopmentService, Manchester Metropolitan University, Employability Hub, Business School & Student Hub, All Saints Campus, Oxford Road, Manchester, M15 6BH

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