Advice Service - Consent Form

To talk to the Advice Service about your academic, housing and/or signposting needs, please complete this form. It's quick to do, and gives us all of the initial information we need, so we can begin advising you.

The Advice Service is currently working on limited capacity. We endeavour to respond to non-urgent cases within 3 working days.

We apologise for any inconvenience but do thank you for your patience and understanding in the meantime.

First Name                                  

Surname                                     

Preferrred Title                          Please SelectMrMrsMsMxMissDrOtherPrefer not to say

University Email Address        

Phone Number                          

Student Number                       

Course                                         

Dept/School                               Leicester Medical SchoolBiological SciencesPsychologyHealthcareChemistryComputingGeography, Geology and EnvironmentEngineeringMathematical SciencesPhysics and AstronomyArchaeology and Ancient HistoryBusinessSchool of CriminologyEducationHistory, Politics and International RelationsLeicester Law SchoolMedia, Communicatiion and SociologyPlease Select HereEnglishModern LanguagesHistory of Art and Film

Year of Study                             1st2nd3rd4th5thFormer StudentProspective StudentRepeat YearYear without ResidenceEnglish Language Teaching CourseOtherPlease Select Here

Level of Study                            Please Select HereUndergraduatePostgraduate TaughtPostgradaute ResearchFormer StudentNon Student

Mode of Study                           Full-TimePart-TimeDistance LearningErasmusPlease Select Here

Fee Status                                   HomeEUInternationalPlease Select Here

Nationality                                  

Expected Graduation Date (DD/MM/YYYY) 

How did you hear about us?

 Students' Union DepartmentStudents' Union Executive OfficerStudents' Union WebsiteStudents' Union Social MediaAccessability CentreCareers ServiceCounselling ServiceAcademic Skills ServiceWelfare ServiceWellbeing ServiceQuality OfficeStudent ServicesPersonal TutorYour Department/SchoolSupervisorI've been the Advice Service beforeOtherPlease Select Here

What area do you need advice on?               

 Mitigating CircumstancesAppeal (Degree Classification/Progression/Termination)Appeal (Plagiarism)Appeal (Attendance)AttendancePlagiarism/CollusionMisconductAcademic ComplaintOIAOther (Academic)Finding HousingMoving In and LivingMoving OutHousing ComplaintUniversity AccommodationSULETSOther (Housing)Signposting for SupportOtherPlease Select Here

Do you have a deadline you need to submit information by ? If so please enter it below (DD/MM/YYYY)

  

Do you give permission for us to share information with other departments, where required?

 yesnoPlease Select Here

Do you have any additional needs (diagnosed or undiagnosed) that we should be aware of when considerng your support?

  

Overview of what you need help/advice on, we will discuss the details with you after receiving the form.

   

Consent & Confidentiality

Before you complete this booking form, which requires you to submit some personal details, we are legally obliged to tell you how we gather this data, what we will use it for and how we will store it. Please read the information regarding this below then check the box to acknowledge that you understand and consent to us using your data in this way. I understand that

• the SU Advice Service have a legal and legitimate interest to collect and process my personal data in order to provide me with advice and ongoing casework and I consent to this
• the SU Advice Service use my personal data to create a case file regarding my query on a secure case management system that only the staff within the SU Advice Service can access. This will allow the advisers to enter notes about my query and the advice I have been provided.
• my case may be reviewed as part of quality assurance auditing. I also understand that under the Data Processing Legislation, I have the right to access information held about me. I understand that I can do this by submitting a data access request at any time by writing to the Manager at the SU Advice Service, stating exactly what I require.
• I can access the SU Advice Service Consent and Confidentiality statement on their website and that I can also request a copy of the SU Advice Service policies relating to Confidentiality and File Storage from any advisor.
• the SU Advice Service will retain my case details for 24 months after the expected graduation date provided and then they will destroy these without referring back to me. 

Do you agree to our consent & confidentiality statement?