Assessor Information Name Email Telephone Assessment Centre Student Information Name Pronouns Date of Birth Email Telephone Funding Body What’s the address of where the assessment will take place? What’s the address of where the equipment will be delivered to? University, course title and dates Approved Conditions Impact On Studies Current equipment (including DSA equipment) Items you wish to be considered: Ergonomic chairSit/stand deskStandard deskWorkstation platformLaptop standErgonomic keyboardErgonomic mouseFoot RestMonitor armDocument holderWrist or arm supportsRolling laptop carry case Additional Information: *please let us know if you do not wish for us to consider certain items, such as laptop bundles/carry cases. Captcha:
