Faculty of
Social
Sciences.
Geography Field Trip Day
Wednesday 22nd April 9.30am – 2.45pm
School
Year Group
Full Name
Home Address
Post Code
Date of Birth
Email Address
Male ☐ Female ☐
Contact Number
I consider myself to have a disability: Yes ☐ No ☐
I have allergies (medical or food related): Yes ☐ No ☐
If yes to either/both questions please provide details so that we can accommodate you on our event:
I am currently living with people other than my parents or under the care of my local authority: Yes ☐ No ☐
Did either of your parents attend University? Yes ☐ No ☐ (this does not include as a mature student)
n you tell us why you want to attend the Geography Field Trip Day?
The data collected here will be stored in accordance with the Data Protection Act and used to administer and manage this application. For
monitoring purposes, this data may also be shared with the Higher Education Funding Council for England (HEFCE) to help evaluate the
effectiveness of this activity as part of the government policy to widen participation in higher education and to develop future
policy. HEFCE & the University of Sheffield will not use your records in a way that would affect you individually.
Under the Data
Protection Act 1998 you have the right to a copy of the data held about you by us, for a small fee. If you have any concerns about the
use of data for these purposes or would like a copy of the data you have supplied directly to us, please contact Sophie Philpott. I agree
that the information requested from my school can to be passed onto the University of Sheffield.
If our events are oversubscribed we will use the information you have provided to prioritise students for places. We
will confirm receipt of your application and will confirm whether you have a place after the deadline for applications.
I agree that photos and other media of me may be used to publicise future activities including use on our website,
social media pages and in the press. I also consent to complete an evaluation of the activities I take part in. I am
responsible for travel to and from the university, unless arranged through school. In the event of an emergency I give
permission for the staff supervising the event to authorise any treatment deemed necessary by a qualified medical
practitioner. I agree to the Faculty of Social Sciences Outreach Team contacting me about other opportunities I might
be interested in.
Student Signature:
Emergency Contact Details for Wednesday 22nd April 9.30am
Name
Date:
Relationship
Contact Number
I agree with the consent above on behalf of my child/ward:
Parent/Guardian Signature:
Print Name:
Date:
Please make sure your teacher signs the other side of this form! Your application won’t be valid without a teacher
signature.
If you would like more information or to discuss anything on this form please contact the Faculty of Social Sciences
Outreach Team: @FSSOutreach on Twitter and Social Sciences Outreach on Facebook
Dear Staff,
If you would like more information about this event, see our website:
www.sheffield.ac.uk/faculty/social-sciences/outreach
Please sign this form to confirm that the above application form is completed accurately and:
1.
That we will receive all relevant information regarding disabilities, learning difficulties and allergies
2.
The students have a minimum of 5 A*-C grades at GCSE (with at least 3 grades B or above and a minimum of
Grade C in English and Maths)
3.
The students are on course to get BBB or higher in their A Levels, or would be with the right encouragement.
This is due to the entry requirements at the University of Sheffield being ABB at minimum.
4.
The students demonstrate commitment to their studies
5.
All would qualify as a home fee paying student (For more info see: http://www.sheffield.ac.uk/ssid/fees/status)
Signature:
Date:
Print Name:
Position:
Contact email:
Contact phone:
Please note – if you have a group of students attending please use the Cover Sheet available on our website, this
means you only have to sign one form on behalf of all of your students (they are still required to fill in an application
form each). It also allows us to have information about booking transport if required. There is more information about
how we prioritise students on our website and cover sheet.
We do not require staff to accompany Year 12/13 students – though you are welcome to attend if you wish.
Please return all application forms with this cover sheet by Monday 23rd March to:
Amy Mollekin
Outreach Activities Assistant
Faculty of Social Sciences
ICOSS, 219 Portobello
Sheffield
S1 4DP