Telephone:03332420312

Email: contact@arkassessments.co.uk
Website: www.arkassessments.co.uk

Pre-Assessment Questionnaire (PAQ)

Please return this form ASAP or at least within 5 working days of the appointment.
(This form can be completed electronically by typing in the boxes)

The purpose of the DSA Study Needs Assessment is to determine what difficulties you may
encounter with your studies due to your disability, and to consider what can be recommended to
overcome those difficulties. The PAQ will help the needs assessor to do any prior research
needed to prepare for your assessment.
Your details:

Surname First name

Date of birth

Term time address (if known) Home address (if different)

Home tel. no. Mobile

Email:
PERSONAL:
UNIVERSITY:
(please provide both if you can)

University ID/Student number

Course Name
University or College name

Are you studying Full Time or Part Time?

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 What month and year did you start your
course? (MM/YY)

What month and year will you finish your

course? (MM/YY)

If you know the name of the course leader

please provide this here

If you know have made contact with the NAME:

disability team at your university or college, ROLE:
please can you note their details here: EMAIL ADDRESS:

ADDRESS:

We will not disclose your identity to your Please confirm if you give your permission to
University/College without your permission. contact your disability officer/course leader:
However, it may be helpful for us to contact
YES/NO
your disability officer/course leader for
information regarding your course

Please provide details of the disability you

are being assessed for (this information
should be on your funding body letter)

How does your disability affect you? You will also be asked about this in the Needs Assessment.

What type of support (if any) have you received in the past e.g., at School or College? Please
indicate if you found it helpful.
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 Please indicate any equipment you already own and provide as much detail as you can about the
equipment in the box below.

If you have a laptop, please bring this with you, or have it available during your online
assessment. (For help on computer specifications please refer to the following link for a
step by step guide: https://www.practitioners.slc.co.uk/media/1755/guidance-for-
assessment-centres.docx )

Yes/No Age Make, model and specification (if known)

Desktop PC
(please also include operating
system, processor number,
Memory (RAM) and available
storage)

Laptop PC
(please also include operating
system, processor number,
Memory (RAM) and available
storage)

Tablet

Printer/scanner/photocopier

Smartphone

Digital voice recorder

Hearing Aids (if applicable)

Other

Have you any prior experience with any kind of enabling technology?

Speech to Text software (for example Y/N Mind mapping software (for example Y/N
Dragon) MindView)
Magnification software (for example Y/N Text to Speech software (for example Y/N
JAWS) TextHelp)
Spellchecking software (for example Y/N Other: Y/N
Grammarly)

Have you ever had a DSA Assessment YES/NO

before?
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 If YES, please can you attach a copy of the
report. If you do not have a copy, please can
you provide details about when and where the
assessment took place.

The following questions only need to be answered if you have trouble travelling to and
from university as a result of your disability.

Do you receive a mobility component of Disability YES/NO

Living Allowance (DLA)?
Do you receive a mobility component of Personal YES/NO
Independence Payment (PIP)?
If you answered yes to the above, does this help fund YES/NO
a Motability car?

For training purposes and to ensure the quality of YES/NO

assessments is maintained, a second member of staff
may occasionally attend the Study Needs
Assessment as an observer of your needs assessor.
Please indicate if you agree to your assessment
being observed.

Important - please read the following statements carefully:

The cost of your Study Needs Assessment will be met from your DSA and on completion we will
invoice your funding body.

By signing this form, you are asking us to arrange your assessment for you and you are giving
your funding body permission to release funds from your DSA to pay for your assessment.

Student Name

Student Signature

Date

Please return the completed form by email to contact@arkassessments.co.uk

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