Student Health & Wellbeing e-Referral

Thank you for contacting the Student Health & Wellbeing Team at City, University of London

The purpose of this form

This form allows you to share information about yourself with us. This will inform future discussions about the type of support you might require at City, University of London.

Applicants and provisional students: please note, this form does not provide indication of a change in your offer status.

About us

We are proud to be an inclusive learning environment. It is our aim to enable our students to achieve their full academic potential and to have an enjoyable student experience.

Our team offers advice and support. This might include:

Students with dyslexia, dyspraxia or dyscalculia
Students with diagnosed ADD or ADHD conditions
Students with a diagnosed, long term physical health condition(s)
Those with a physical disability or sensory condition
Students with a diagnosed autism spectrum disorder (ASD)
Students with diagnosed mental health conditions
Students wishing to access counselling support

You can find out more about our Team on our webpages.

You can find further information about how your special category data will be managed via our data protection pages https:// www.city.ac.uk/about/governance/legal/data-protection.

All information held by the Multidisciplinary Team is confidential and will only be disclosed to relevant parties at your request and/or with your knowledge. Multidisciplinary Team staff attend external supervision, similarly bound by confidentiality. The only exception arises where there is concern for the safety of individuals. In order to facilitate your support, we may be required to disclose relevant information to the following teams. Please note this list is not exhaustive. You may choose to decline to provide consent, however this may impact on our ability to provide support to you.
* G.P. Surgery
* Care Leavers Team
* Academic Department
* Dyslexia Assessors
* Exams Office
* External Support e.g. NHS, voluntary sector and private
* City University London Libraries
* Occupational Health / Health Care Services
* Disabled Students Allowance provider and related services
* Student Centre
* Social Services
* Student Union Advice Centre
Any information you disclose regarding your disability or specific learning difference is considered sensitive and personal. All personal information shared with these teams is protected by the General Data Protection Regulation (2018) and is stored securely on our database for a maximum period of seven years. It will remain strictly confidential and only be disclosed to relevant parties with your knowledge and consent. The only exception arises where there is serious concern for individual or public safety. Staff attending supervision are similarly bound by confidentiality. Further information on City's Privacy Notice for past, present and prospective students is available here. Please acknowledge your agreement to the above and consent to our data protection arrangements. Please note, this must be completed by you, the student.
We strongly recommend you consider registering with a GP for the duration of your studies

About You

Personal Details

Student

Case Subject

First name

Surname

Email Address

Mobile number

Course applied for

Date of Birth

Student ID (if known)

Preferred name

Let us know which pronouns you'd like to us to use

I am a...

The purpose of this form

About us

Thanks for your submission

About You

Personal Details