UWLSU Advice Service Booking A Form

Full Name
Student ID Number / Date of Birth / Click here to enter a date.
☐ Prefer not to say
Course Title / Year of Study
Contact Number / Email address
How did you hear about the Advice Service?
☐Course Department / Tutor
☐Advice on Tour
☐Friend / Other Student
☐Leaflet / Promotional Material
☐Big Conversation / Induction
☐UWLSU Website
☐Other University Service / What campus do you study at?
☐St Marys Road
☐Paragon
☐Reading Fountain House
Your Ethnic Origin
These categories are based on the Census 2011 categories and recommended by the Commission for Racial
Equality.
Asian, Asian British, Asian English, Asian Scottish, or Asian Welsh
☐Asian / Asian British
☐Bangladeshi
☐Chinese
☐Indian
☐Pakistani
☐Other Asian background (specify if you wish): / White
☐British
☐English
☐Gypsy or Irish
☐Traveller
☐Irish
☐Scottish
☐Welsh
☐Other White background (specify if you wish): / Black, Black British, Black English, Black Scottish, or Black Welsh
☐African
☐Caribbean
☐Other Black background (specify if you wish) / Mixed
☐White and Asian
☐White and Black African
☐White and Black
☐Caribbean
☐White and Chinese
☐Other mixed background
(specify if you wish):
☐ Prefer not to say
Your Gender
☐ Male
☐ Female
☐ Other (specify if you wish):
☐ Prefer not to say / Your Orientation
☐ Bisexual
☐ Gay man
☐ Gay woman/lesbian
☐ Heterosexual/straight
☐ Other (specify if you wish):
☐ Prefer not to say / Your religion or belief
☐ No religion
☐ Buddhist
☐ Christian (including Church of England, Catholic, Protestant and all other Christian denominations)
☐ Hindu / ☐ Jewish
☐ Muslim
☐ Sikh
☐ Other (specify if you wish):
☐Prefer not to say
Care Of Dependents
Are you currently the parent/guardian or carer for anyone? E.g. children, elderly relatives.
☐No
☐Yes - Parent
☐Yes- Guardian
☐Yes- Carer
☐Prefer not to say / Disability
The Equality Act 2010 defines a disabled person as someone who has a physical or mental impairment which has a substantial and long-term adverse effect on their ability to carry out normal day-to-day activities.
Do you consider yourself to be disabled?
☐Yes. Please specify:
☐No
☐Prefer not to say
Disclosure Authorisation
I authorise the release of any information regarding my case held by the University of West London or any external body that my caseworker may request.
I also authorise West London Students’ Union to be copied into any correspondence that relates to my case.
I further authorise West London Students’ Union to act on my behalf when arranging the timings of meetings, interviews and hearings.
Data Protection
The University of West London Students’ Union is fully committed to upholding the principles laid out in the Data Protection Act 1998. The Union’s Data Protection policy is available from the Union’s website.
I hereby give permission under the Data Protection Act 1998 for The University of West London Students’ Union to process the data on this form for the purposes of keeping a record of your case and monitoring engagement with West London Students’ Union’s Advice Service.
Students have the right to see the information held on them by UWLSU Advice. Students should be advised that requests must be made in writing to the Advice & Outreach Manager (), who should respond within 5 working days.
As part of UWLSU Advice’s ongoing commitment to delivering excellence in its service, we are periodically audited by an assessment team from The Advice Quality Standard. By signing this form you are consenting to your case file being reviewed by an AQS Assessor as part of their audit of our service standards. If you have any questions about this, you can email the Advice & Outreach Manager (), who should respond within 3 working days.
Confidentiality
UWLSU Advice operates a confidential service. This means that we will not share anything you tell us outside our team unless you give us consent to do so.
No information will be given to any external agency without the student’s express consent unless the provision of such information is required by law. The Caseworker may, however, decide that information should be disclosed without consent if in their judgement there is risk of immediate physical danger to the student or others.
We may have to inform a third party if you tell us something which leads us to believe that you may be:
  • At risk of causing harm to yourself;
  • At risk of causing harm to someone else;
We are legally obliged to inform a third party if you disclose to us that you may be:
  • Laundering money or committing fraud; or
  • Committing acts of terrorism.
Consent should normally be given in writing, but if this is not possible, then verbal consent must be obtained and recorded on the case record.
Full Name
Student ID number
Signed
Date