Brain in hand - personal technology for independant living

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To help us provide your support, please answer the following questions.

If you would prefer to register by phone, please contact us on 01392 247909 and we will be happy to help.

 

Complete as much of the form as possible.  If there is information you do not know, leave the space blank.

If you have any questions, you can ask them at the end of this form.

 

About You...

We need this information to confirm your funding, identify who your local Specialist Trainer is, and send out your Brain in Hand licence activation link.
Student's name:
Student's preferred name (if different):
Student's Date of Birth:
Student's Home Address:
Student's Term-Time Address:
Student's Contact Number(s):
Student's Email Address:
 




If you would like us to contact or copy in anyone else to support you when making arrangements for your Specialist Training (for example a family member), please provide their details below.
Supporter's Name:
Supporter's Relationship to you:
Supporter's Contact Number(s):
Supporter's Email Address:
By providing us with this information you agree we can discuss the details of your Brain in Hand service provision with the person named above.




About Your University Support…

We will contact your University and your Non-Medical Help Provider to offer them information about Brain in Hand.
University Attending:

My first academic year of DSA funding for Brain in Hand is:

My final academic year will be:
My mode of study is:
Disability Advisor (if known):
Which organisation provides / will provide your Specialist Mentoring service?
Specialist Mentor's Name:
Specialist Mentor's Contact number:
Specialist Mentor's Email:
We routinely send Universities updates about the student support we deliver.  Brain in Hand can be used within your university support sessions and your supporters may contact us to discuss your Brain in Hand provision.  We are also regularly audited to ensure the quality of our service and your data may be provided to the auditor for the specific purpose of carrying out the audit of our organisation.

If you are happy for us to use and share your information in this way you do not need to do anything.  However, if you would prefer us to exclude your update, not to discuss your service provision with supporters, or not include your data in our audit process please let us know your consent to share preferences.  You can update your consent to share preferences at any time by visiting our Student Support page (this link will be emailed to you after you register with us).




Your Brain in Hand Specialist Training…

What happens now?

1)   When we have received this registration form and a copy of your DSA2 letter, we will create your Brain in Hand account


2)   We will allocate you a Specialist Trainer to help you set up Brain in Hand and support you to develop your first strategies
 Please note: we will share the contents of your registration form with your Specialist Trainer so that they can best support you to get started
If you do not want us to share your contact details, university or supporter information or preferences please email us and let us know.



3)   Your Specialist Training may be provided at home before you go to university or on campus once you are there


4)   Your Specialist Trainer will contact you to arrange a suitable time for your first session


5)   We will encourage you to invite your Specialist Mentor or another supporter (such as a family member) to your Specialist Training


6)   Once your Specialist Training session has been arranged, you will receive a link to activate your Brain in Hand account so you can get started together.




If you would like us to send you a link to activate your Brain in Hand independently prior to your training session, please email us (or reply to our confirmation email) to let us know.
Please let us know if you have any communication preferences or needs that we should be aware of when arranging or delivering the session:
Please tell us if you have preferences about where and when you would like your Specialist Training to take place:
 




 

Your Needs Assessment...

Your Needs Assessment Report (NAR) will help your Specialist Trainer to understand why you have been recommended Brain in Hand.

If you are happy to share this, please email us a copy of your Needs Assessment Report to DSA@braininhand.co.uk
Alternatively, please let us know where your DSA needs assessment was completed, so that we can contact them and request a copy directly:
By providing us with this information you agree we can discuss the details of your Brain in Hand service provision with the organisation named above.




Your Brain in Hand…

The free Brain in Hand app can be downloaded from the Apple App Store onto iOS devices (version 8+) or the Google Play Store onto Android devices (version 4.0.3+).

For a step-by-step guide to downloading the app and information about compatibility please click here.




Please visit our University Edition Student Support page to find out more about Brain in Hand and Specialist Training, look at our support materials or read our policies.

Here you will find our Terms & Conditions, our cancellation policy and our complaints procedures.

The link to these resources will be emailed to you again when you activate your licence and can also be found by following the link at the bottom of your Brain in Hand profile page once your account is active.

Thank you for completing our registration form

A member of our team will be in touch soon to arrange your first Specialist Training session.

Name of person completing this form: Please provide an email address in the box below if you would like to receive a copy of your answers: