Faculty of
Social
Sciences.
Economics Event with Knoop Lecture
Monday 7th December 2015 1.15-6.15pm
School
Year Group
Full Name
Home Address
Post Code
Male ☐ Female
☐
Date of Birth
Email Address
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 below:
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)
Can you tell us why you want to attend the Economics Event with Knoop Lecture?
The data collected here will be processed by the University of Sheffield in accordance with the Data
Protection Act 1998 and held for an extended period of time. For research, monitoring and evaluation purposes only, your data may also be
shared with appropriate third party organisations such as the Higher Education Funding Council for England, Higher Education Statistics
Agency and our partners including Higher Education Access Tracker Service subscribers. We will not release data to anyone who is
unauthorised. Under the Data Protection Act 1998 you have the right to a copy of the data held about you by us. If you would like a copy of
the data you have supplied to us, please contact outreach@sheffield.ac.uk. By submitting your application, you are consenting to the use of
your data as outlined above.
If you do not wish to be contacted by the University of Sheffield about future activities, please tick here ☐
As part of this application, we have collected data regarding ethnicity, disability and health and social care for monitoring equality of
opportunity under the Equality Act 2010. Please tick here if you are happy for this information to also be used for evaluation and monitoring
purposes ☐
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:
Date:
Emergency Contact Details for Monday 7th December 2015
Name
Relationship
Contact Number
I agree with the consent above on behalf of my child/ward:
Parent/Guardian Signature:
Print Name:
Date:
If you would like more information or to discuss any points on this form please contact the Faculty of Social
Sciences Outreach Team: @FSSOutreach on Twitter and Social Sciences Outreach on Facebook
Please make sure your teacher signs the other side of this form! Your application will not
be valid without a teacher signature.
Dear Staff,
Further information about this event can be found on our website: www.sheffield.ac.uk/faculty/socialsciences/outreach
Please sign this form to confirm that the above application form is completed accurately and that:
1. 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. Year 12 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 provides us with information about booking transport if required.
More information on how we prioritise students is available on our website and cover sheet.
Staff are not required 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 16th November 2015 to:
Victoria Large
Faculty Outreach Activities Assistant
Faculty of Social Sciences
ICOSS, 219 Portobello
Sheffield
S1 4DP