Appointment request form - Current students

In Staffordshire Regional Access Centre

Please ensure you have your documents available as we will ask you to send them to us within five working days of booking your appointment. We have availability for appointments at Stoke, Stafford, Shrewsbury or remotely (online or telephone). Please specify your preference when indicating your availability. We are currently offering appointments within 5 working days.

Your details
* denotes a required field
Name

First name

Last name
Date of birth

Format dd/mm/yyyy
Phone number
Email address
Location
Disability
Customer Reference Number
I confirm that I have received approval of funding to book a DSA Study Needs Assessment
YesNo
Please state your funding body
Please state your Higher Education provider
Availability - please help us to help you by giving preferred dates and times which we will try to accommodate. Please ensure you have your documents available as we will ask you to send them to us within five working days of booking your appointment.
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