Covid Panel | Student Hut

First Name

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Last Name

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Email Address

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Date of Birth

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Which best describes you?

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What year are you in?

Year 11 Year 12 Year 13 Other

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Gender

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What country are you from?

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What country do you currently live in?

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Which county do you live in?

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What is your home postcode?

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Please select your nationality

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What year did you finish at college/sixth form?

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When did you graduate?

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What year will you finish at college/sixth form?

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Please select your highest level of education

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A-Level 1

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A-Level 2

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A-Level 3

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A-Level 4

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Please state the university you study at

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Please state the university you study at

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Please state the university you studied at

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Please state the university you studied at

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What year did you start your programme in?

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Please select your graduation year

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Please select your subject area

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How is your degree taught?

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What is your mode of study?

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Are you interested in going to uni?

Yes No Unsure

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Please select the subject area you're interested in studying at uni

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Please select your first choice university

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Please select your second choice university

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Are you the first person in your family to go to university (not including any siblings)?

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UCAS points (achieved or predicted)

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Are you interested in a postgraduate degree?

Yes No Unsure

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Please select the subject area you're interested in studying at postgraduate level

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Do you consent to Student Hut processing your special category data?

I consent I do not consent

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What is your ethnicity?

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Have you been diagnosed with any of the following?

A sensory impairment (vision or hearing) A mobility impairment A learning disability (e.g. ADHD, dyslexia) A mental health disorder A disability or impairment not listed above I have not been diagnosed with any of the above Prefer not to say

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I confirm that I am aged 16 or above

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