Faculty of
Social
Sciences.
Things You Can’t Do in School – Wednesday 18th May 2016, 09:3014.45pm
Student Name
School/College
Date of Birth
Year Group:
Male/Female (please delete as appropriate)
Home Address
Post Code
Home Telephone Number
Mobile Number
Email Address
I consider myself to have a disability: Yes ☐ No ☐
Please tick the category which most
I have allergies (medical or food related): Yes ☐ No ☐
closely resembles your ethnic origin
White
If yes to either/both questions please provide details so that
Gypsy or Traveller
we can make appropriate arrangements for you:
Black or Black British Caribbean
Black or Black British - African
Other Black Background
Asian or Asian British - Indian
Asian or Asian British - Pakistani
Asian or Asian British Bangladeshi
Chinese
Other Asian background
Mixed - White and Black
Caribbean
Mixed - White and Black African
Mixed - White and Asian
Other Mixed background
Arab
Other Ethnic background
Not known
Prefer not to say
Did either of your parents attend University? Yes ☐ No ☐ (this does not include as a mature student)
I am a looked after young person(I am cared for by people other than my parents or under the care of my
local authority)
Please tell us why you want to attend the Things You Can’t Do in Schools event
Emergency Contact Details for Things You Can’t Do in Schools event
Yes ☐ No ☐
Faculty of
Social
Sciences.
Name
Relationship
Telephone Number
Mobile Number
Parent/Guardian(sign)____________________Print______________________Date___________
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.
Signature of applicant: ______________________________ Date __________________
Please make sure your teacher signs 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
…………………………………………………………………………………………………………
Section to be completed by the School/College
Faculty of
Social
Sciences.
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 the cover sheet either by post or email by Wednesday 27th April
2016 to:
Victoria Large
Faculty Outreach Activities Assistant
Faculty of Social Sciences
ICOSS, 219 Portobello
Sheffield
S1 4DP
Email: V.Large@sheffield.ac.uk