Application for a Continued Disabled Students' Allowance (DSA)

For disabled Open University (OU) students who live in England, Wales or Northern Ireland and are studying part time towards a qualification of 60 credits.

You should apply as early as possible to ensure your application is processed in time for your new modules.

How to complete your application form 1. There are instructions for some questions. You should read these before you fill in

your answer.2. Do not skip a question unless the form tells you to do so.3. You may be required to submit supporting evidence with your application.

The evidence warning triangle shows what evidence you need to attach toyour form.

4. Submit your completed form and any supporting evidence to the DSA Office inthe same envelope.

Page 9 has further advice about completing your application.

Please contact the DSA Office if you need this form in an alternative format. Our contact details are on page 8

Instructions Left hand pages

Questions Right-hand pages

Instructions for question 3 DSA can only support study towards one qualification at a time so you should answer question 3 carefully and in full. You must state your qualification, not your current modules.

Example

Instructions for question 4 The term Specific Learning Difficulty (SpLD) includes dyslexia, dyspraxia, attention deficit disorder, dyscalculia and dysgraphia. SpLD tuition is not the same as mentor support.

Instructions for question 6 Any request for further Specific Learning Difficulty (SpLD) tuition must be supported by a copy of your current Individual Learning Plan. If you do not already have a copy, your SpLD tutor can provide you with one.

The DSA Office cannot obtain a copy of your Individual Learning Plan on your behalf. You must obtain this evidence yourself and you must submit it with your Continued Funding application form. Do not send it separately.

If you are requesting further SpLD tuition, your Individual Learning Plan must clearly demonstrate that you are benefitting from this type of support by becoming more autonomous in your learning environment. It must also clearly demonstrate why you need further support of this nature. There must be a section which clearly summarises:

1. Goals already achieved during previous SpLD tuition sessions. This mustaccount for all the hours of SpLD tuition previously funded through your DSA.

2. All your remaining goals.3. The specific number of additional hours being requested.

For more information on Individual Learning Plans, please refer to the Frequently Asked Question section on pages 10 and 11.

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1 Your OU Personal Identifier (PI) Go to question 2

2 Your title (Mr, Mrs, Miss, Ms, etc.)

Your first name/s

Your surname Go to question 3

3 Please state your OU qualification code, its full title and the total number of credits required to complete it. Instructions notes on page 2.

Go to question 4

4 Have you previously been awarded DSA support for Specific Learning Difficulty tuition? Instructions notes on page 2. No ☐ Go to question 7 Yes ☐ Go to question 5

5 Did you take up the Specific Learning Difficulty tuition? No ☐ Go to question 7 Yes ☐ Go to question 6

6 Does your current Individual Learning Plan demonstrate that you need further Specific Learning Difficulty tuition? Instructions notes on page 2. No ☐ Go to question 7 Yes ☐ please attach a copy of your current Individual Learning Plan to this

application form

If you do not attach a copy of your current Individual Learning Plan, your request for further Specific Learning Difficulty tuition cannot be considered.

Tick here to confirm you have attached a copy of your current Individual Learning Plan ☐Go to question 7

Code Full title Credits

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Instructions for question 8 If your additional disability-related study needs are a result of a change in your disability you must provide new evidence to support this. Please note we cannot accept benefits letters or appointment letters because they do not show the information we need.

If the evidence confirms there has been a substantial change in your disability, it is likely that you will be entitled to a reassessment of your disability-related study needs

This is the only evidence we can accept for a physical disability, sensory disability or mental health condition:

• A recent letter from your GP or appropriate medical specialist (e.g. hospitalconsultant) which confirms the nature of the change in your disability. Ideally, theletter should briefly explain how you are affected by it. The doctor’s field ofexpertise must be relevant to the change they are confirming. If you have acquiredan additional disability, the letter must also confirm that the impairment has asubstantial and long-term (more than 12 months) adverse effect on your ability tocarry out day-to-day activities.

• If you are blind or visually impaired you can submit proof of registration as a blindor partially sighted person from your Social Services Office.

This is the only evidence we can accept for dyslexia or other Specific Learning Difficulty (e.g. dyspraxia, attention deficit disorder, dyscalculia, dysgraphia):

• A full diagnostic assessment report which meets DSA standards. We cannotaccept any other type of evidence of your Specific Learning Difficulty. Ascreening test is not sufficient. The DSA Office has an advice sheet about howto obtain the evidence we need. Please contact us if you would like a copy. Ourcontact details are on page 8.

A DSA cannot be used to pay for the cost of obtaining new medical evidence or diagnostic reports but the OU itself may be able help with these costs. You should ask your OU support team for further information if you need help with these costs.

If you are having trouble obtaining the required medical evidence, please contact the DSA Office for advice. Our contact details are on page 8.

Please refer to our Data Protection statement on page 13 if you have any concerns about how your personal details will be used.

Instructions notes for question 9 Please describe your additional disability-related study needs and why they have arisen. If you need to continue on a separate sheet, please ensure it is firmly attached to your application form.

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7 If you are eligible for Continued DSA Funding, your award will be based on your existing Needs Assessment Report. Do you have any additional disability related study needs that the DSA Office is not already aware of? No ☐ Go to Your Declaration and Agreement (page 7) Yes ☐ Go to question 8

8 Are your additional disability-related study needs a result of a change in your disability? Instructions notes on page 4. No ☐ Go to question 9 Yes ☐ Please attach documentary evidence of this change to your

application.

Tick below to confirm what disability evidence you have attached

For a physical disability, sensory disability or mental health condition:

☐ A recent letter from your GP or appropriate medical specialist (e.g. hospital consultant)

☐ Proof of registration as a blind or partially-sighted person from your Social Services Office

For dyslexia or other Specific Learning Difficulty (e.g. dyspraxia, attention deficit disorder, dyscalculia, dysgraphia):

☐ A full diagnostic report carried out by a suitably qualified specialist after you reached the age of 16. A screening test is not sufficient.

Go to question 9

9 Please describe your additional disability-related study needs. If you are requesting a specific item or service you must describe how it is directly related to your disability and why your existing award no longer meets your disability-related study needs. Instructions notes on page 4.

Go to Your Declaration and Your Agreement (page 7)

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Instructions for Your Declaration and Your Agreement If your disability makes it impossible for you to sign the form we will accept the signature of someone who has a Lasting Power of Attorney to sign on your behalf. Please send a copy of the document granting the Lasting Power of Attorney with this application.

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Your Declaration and Your Agreement Please read the undertakings below carefully. If you agree to abide by them, write your signature, name and the date in the appropriate boxes. Please read the notes on page 6 if your disability makes it impossible for you to sign the form yourself.

We cannot consider your application for a DSA unless you agree to all of these undertakings.

I declare:

• That the information I have given and the evidence I have submitted is complete andaccurate to the best of my knowledge and belief.

I understand and accept:

• It is my responsibility to inform the OU DSA Office immediately and in writing if thereare any changes to my circumstances which could affect my eligibility for a DSA. Thisincludes changes to my address, to my disability or to my study intentions.

• If, for any reason, DSA funds paid to me or on my behalf are more than I am entitledto, I will repay them.

• If I fail to give complete information, or if I give false information, my application willbe cancelled, any future application may be rejected, financial support may bewithdrawn and I may be prosecuted.

• The OU always refers suspected cases of fraud to the police.• DSA funds cannot be used to repair or replace DSA funded equipment that has been

lost, stolen, damaged or misused.

I will:

• Use all equipment and services funded by a DSA for my OU studies.• Take full responsibility for the proper care and upkeep of all DSA funded equipment.• Ensure all DSA funded equipment is covered by all-risk insurance for the duration of

my studies.• Submit a request to the DSA Office if I need help with the cost of insurance.

I consent:

• To the OU DSA Office disclosing, only when necessary, information related to myDSA to a third party, such as an Assessment Centre or service provider, who needthe information to assist the DSA Office in dealing with my application or award.

• To the OU DSA Office ordering approved equipment on my behalf from therecommended suppliers and making DSA payments to those suppliers on my behalf.

Page 8 tells you how to submit your completed application.

Your name Your signature Date

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How to submit your application When you have completed your application, you should:

1. Firmly attach any supporting evidence to your form to create one bundle.2. Post the bundle to The DSA Office (address below).

Please ensure you pay correct postage.

In your own interests, you may wish to send your application to the DSA Office via ‘Recorded Signed For’ delivery.

Do Not send original documents to the DSA Office. We cannot accept any responsibility for loss or damage.

Please retain a photocopy of your application for your own reference.

DSA office contact details Address: The DSA Office

The Open UniversityHammerwood GateKents HillMilton Keynes MK7 6BR

Email: Phone: Web:

dsa-queries@open.ac.uk 01908 654136 www.open.ac.uk/dsa

Opening Times: Monday 11:00am – 4:00pm Tuesday 11:00am – 4:00pm Wednesday 11:00am – 4:00pm Thursday 11:00am – 4:00pmFriday 11:00am – 4:00pm Saturday Closed Sunday Closed

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Tips • Apply as early as possible.• Ensure your answers are clear. Ideally, complete the form in BLOCK CAPITALS.• Work through the numbered questions in order. Do not skip a question unless the

form instructs you to do so.• Answer each question in full and as accurately as possible. If there are

instructions for a question, please read these before you fill in your answer.• Continue on a separate sheet if there is not enough space on the form to answer in

full. Firmly attach your continuation sheet to the form.• Pay careful attention to any request for supporting evidence.• Firmly attach any supporting evidence to your application form. Do not send it

separately.• Ask for help if you need it. Our contact details are on page 8.

Extra help with your application • The OU DSA Office Team is here to help you. Please do not hesitate to contact us if

you need any help completing your application form or if you need advice on whatsupporting evidence you need to provide. We are happy to help. Our contact detailsare on page 8.

• If it is difficult for you to write by hand, you can ask someone to help you. If someoneelse fills the form in on your behalf, make sure the answers are your own before yousign it.

• The notes on page 6 tell you what to do if you can’t sign the form yourself.• There are frequently asked questions and answers on pages 10 to 12.• This application form is available online and in electronic and audio formats.

Please contact the DSA Office if you need it in an alternative format.• If you have any concerns about how your information and evidence will be used or

stored, please refer to our Data Protection statement on page 13.• You may wish to visit our website for more information about DSA for OU students:

www.open.ac.uk/dsa

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Frequently Asked Questions

I’ve had DSA support before. Am I automatically eligible for Continued DSA Funding? No. We ask you to submit an application for Continued DSA Funding in order to assess whether you are still eligible for this type of support. There are several factors that can affect your eligibility for Continued DSA Funding so you are advised not to engage any non-medical helpers until we have confirmed the outcome of your application in writing. If you are not eligible for further DSA support, we will advise you what to do next.

Do I have to complete my qualification within a time limit to remain eligible for DSA support? Yes. The time limit for your qualification depends on when you started studying toward your qualification, how many credits you need to attain for your qualification and where you live.

When can I apply for Continued DSA Funding? You can apply at any time between reserving your place on your new module and completing it but you should apply as early as you can.

The form says I need to submit a copy of my current Individual Learning Plan if I want more specialist tuition. What is an Individual Learning Plan? An Individual Learning Plan is not the same as your Needs Assessment report or Specific Learning Difficulty diagnostic report.

You would have formulated your Individual Learning Plan with your Specific Learning Difficulty (SpLD) tutor in your early SpLD tuition sessions. The plan would have been regularly updated to form a record of your progress from the beginning of your SpLD tuition to the current date. Your Individual Learning Plan is a detailed record of how previous SpLD tuition hours have been used and whether you are benefitting from this support by becoming more autonomous in your learning environment. It also shows if and why you may need more specialist tuition.

Why does the DSA Office need a copy of my Individual Learning Plan? You are not expected to need Specific Learning Difficulty (SpLD) tuition for the duration of your studies because this type of support teaches generic skills that can be transferred from module to module. Requests for additional hours are considered on a case-by-case basis.

We need a copy of your Individual Learning Plan in order to establish whether you have benefitted from the DSA-funded SpLD tuition you have already received by becoming more autonomous in your learning environment. We also need to establish why the amount SpLD tuition you’ve already received isn’t enough.

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I don’t have a copy of my current Individual Learning Plan. What should I do? You should contact the person or organisation who has been providing your Specific Learning Difficulty tuition and ask them for a copy. You should ask for it to be sent directly to you. Do not ask for it to be sent directly to the DSA Office.

When you have a copy of your current Individual Learning Plan, you should attach it to your application form before sending it to the DSA Office for consideration.

If you are having trouble getting hold of copy of your current Individual Learning Plan, please contact the DSA Office for advice before you submit your application form.

Can I submit the form now and send a copy of my current Individual Learning Plan later? You should submit a copy of your current Individual Learning Plan with your application form. Please do not send it separately.

I was awarded DSA support in the past for Specific Learning Difficulty tuition but I would rather have a different type of support. Can I use a Specific Learning Difficulty tuition award to pay for something else? The purpose of specialist SpLD tuition is to develop your skills for autonomy in the learning environment. An award for specialist SpLD tuition cannot be used to pay for any other type of support. For example, it cannot be used to pay someone to carry out course related tasks on your behalf like proof reading, typing, structuring assignments or interpreting assignment questions.

In addition, a DSA cannot be used to pay for extra academic tuition in your chosen subject area. If you need this type of support, you should contact your OU support team for advice.

My disability has changed and the form says I need to submit new evidence to confirm this. Can I submit the form now and send the evidence in later? You should submit the new evidence with your application form. Please do not send it separately.

My disability hasn’t changed. Do I need to submit up-to-date medical evidence? No. However, if you are requesting DSA funding for additional items or services, you will need to clearly explain why your disability related need for them has not been identified before.

If I make a request for extra items and services, am I less likely to be awarded Continued DSA Funding? No. A request for additional support will not adversely affect your application for Continued DSA Funding.

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Will I automatically be awarded DSA support for the additional items I have requested? No. If you are eligible for Continued DSA Funding, a DSA Awards Officer will consider whether the additional items you have requested can be funded by your DSA. The outcome will be confirmed in your Continued DSA Funding award letter.

Can my DSA be used to reimburse me for study related items I’ve already purchased? No. We can only consider recommendations for things you have not yet purchased.

Will I need to have my study needs assessed again? If your disability hasn’t changed, you won’t usually need to have another Study Needs Assessment. If there has been a change in your disability, it is likely that you will be referred for a reassessment for your study needs. After the reassessment, your Needs Assessor will make a written summary of any additional support they are recommending for you. They will pass a copy of this summary to the DSA Office for consideration. A DSA Awards Officer will then decide whether the recommendations are eligible to be funded by your DSA. We will write to you to confirm the outcome.

How are DSA-funded equipment and services provided? If DSA support is awarded for additional specialist equipment, the DSA Office will usually order it for you from an approved supplier. The supplier will then deliver the equipment to you and invoice the DSA Office for payment. If you are awarded DSA support for additional non-medical help, we will give you details of an agency who can assist you with finding a helper.

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Data Protection Act 1998 The following statement describes who will use the information provided on this form and what they will use it for.

The Open University’s DSA Office will use the information and evidence you provide to process your DSA application.

The Secretary of State for Business, Innovation and Skills has transferred certain functions relating to your DSA application to The Open University. The Student Loans Company (SLC) also carries out functions on The Secretary of State’s behalf.

The Open University’s DSA Office needs the information and evidence you provide to work out whether you are eligible for DSA support and assess the maximum amount of support you are entitled to.

The Open University’s DSA Office will keep personal information about you so that we can audit the assessment of DSA. If you would like to see your information please contact The Open University’s Data Protection Coordinator.

We may make the result of your application available to the SLC in order for them to maintain or develop their systems. The SLC will have to keep personal information about you for these purposes.

The Department for Business, Innovation and Skills is a data controller for the information you give on this form as it is responsible for it by law. The Department for Business, Innovation and Skills may use the information you have provided on this form to monitor the performance of the DSA system and to develop future policy. Any published statistical work will be anonymous and will not identify individuals.

The Higher Education Funding Council for England (HEFCE) and the Higher Education Statistics Agency (HESA) may use the information provided on this form. This information together with other information supplied by institutions will be analysed. The HEFCE and the HESA will not identify individuals in any published results.

By law, The Open University and the SLC must protect the public funds they handle and may use the information you have provided on this form to prevent and detect fraud. They may also share the information, for the same purposes, with other organisations which handle public funds.

The Open University Student Service

The Open University is incorporated by Royal Charter (RC 000391), an exempt charity in England and Wales and a charity registered in Scotland (SC 038302).

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