ࡱ> s bjbj\\ 6ij6ijzz  \\\ppp8LpoZx:---ZZZZZZZ!^`Z\---^--Z  )ZC2C2C2-^  8ZC2-ZC2C2RDVP=S.^S"Y?Z0oZSYa.YaDVYa\VC2---ZZ0---oZ----Ya---------zX : Lifelong Learning foundation years: U21 Disrupted Studies form Lifelong Learning foundation year courses can only consider non-mature applicants those who are under 21 years of age where they have not been in recent, full time, post-16 education or where they have experienced extenuating circumstances which have had a demonstrable impact on Level 3 (A Level or equivalent) achievements. This form is for applicants to Lifelong Learning foundation year courses aged under 21 to notify the СŷƵ of Sheffield of issues of a personal, social or domestic nature that have affected the completion of any post-16 studies, or any GCSE-level subjects cited in our course entry requirements. Applicants are also expected to demonstrate previous work, life and educational experience in lieu of formal qualifications. If you have not covered this in your UCAS personal statement, please add any relevant additional information to this form. This may include an additional reference from an employer, if appropriate. Further guidance is available at HYPERLINK "/study/policies/disrupted-studies"www.sheffield.ac.uk/study/policies/disrupted-studies PART 1: To be completed by the applicant Personal information TitleForename/Given name(s)Surname/Family nameTelephone numberEmail addressUCAS ID/Sheffield applicant number Course information Please list the Lifelong Learning foundation year course or courses which you have applied to study Course titleCourse code Applicant statement Please tell us about the circumstances you would like us to consider alongside the information in your UCAS application. Where appropriate provide supporting evidence (for example medical correspondence) and details of any relevant personal, work or non-examined educational experience which means that you meet the entry requirements (HYPERLINK "http://www.sheffield.ac.uk/education/lifelong-learning"www.sheffield.ac.uk/education/lifelong-learning) for the Lifelong Learning foundation year courses.  Please pass the form to your UCAS referee to complete the second page PART 2: To be completed by the UCAS referee or appropriate third party Referee information Name of refereePositionName of school/collegeUCAS school codeTelephone numberEmail address Referee statement Please provide a short statement to corroborate the applicants account. We would welcome information about the dates/times when the circumstances occurred, the applicants academic trajectory and any barriers to their continuation in post-16 education.  PART 3: Supporting document(s) Please indicate which item(s) of third-party evidence you will provide in support of your statement. Examples might be a letter from your doctor, a death certificate, or correspondence with a social worker.  PART 4: Declarations REFEREE DECLARATION I confirm that the information provided on this form is a complete and accurate record and that no material information has been willingly omitted. I give my consent to the processing of this information by the СŷƵ of Sheffield. Signed.................................................................................................................... Date........................................................... APPLICANT DECLARATION I confirm that the information I have provided is a complete and accurate record and that no material information has been willingly omitted. I give my consent to the processing of my data by the СŷƵ of Sheffield. Signed.................................................................................................................... Date........................................................... Please submit the completed form and any supporting evidence by email to  HYPERLINK "mailto:disruptedstudies@sheffield.ac.uk" disruptedstudies@sheffield.ac.uk or on paper to: Admissions Service, СŷƵ, Level 2, Arts Tower, Western Bank, Sheffield, S10 2TN      Admissions Service ":;>?@Qahi  ŵ~vnv~~TE~~h 8hCJ OJQJaJ 2h 8hB*OJQJ^JfHphA@Bq hnpOJQJhMYOJQJh 8hOJQJh 8h5CJ OJQJhnpOJQJ\hMYOJQJ\h 8hOJQJ\h 8hc5CJ OJQJaJ h 8hF)5CJ OJQJaJ hnp5CJ OJQJaJ hMY5CJ OJQJaJ h 8h5CJ OJQJaJ ?@  t"d$If]gd t"d$Ifgd t"d$If]gd6 t"d]gd6 d]gd6 Ld]gd Ld]gd6      f g h    & ' ȶЧxl`lQh 8hF)CJ OJQJaJ h 8h65OJQJh 8hF)5OJQJh 8hcCJ OJQJaJ h 8hm[5CJOJQJaJh 8hc5CJOJQJaJh 8h+/0JOJQJ^J#jh 8h 8OJQJUh 8OJQJjh 8h+/OJQJUh 8hOJQJh 8hcOJQJh 8hF)OJQJ -kd$$Ifl\5&>   t05&64lalp t"d$Ifgd    & ' 5 6 Ukd$$Ifl0a 5&a   t 05&64lalp  t"d$Ifgd t"d$If]gd' 5 6 7 Z [ \ ] c d e p q VXYkҷҷwkw`wkhnphnpOJQJjhnpOJQJUhnpOJQJh 8hU5OJQJh 8hU5>*OJQJhMYOJQJh 8h?OJQJh 8hOJQJh 8hF)CJ OJQJaJ h 8h65OJQJh 8hF)5OJQJh 8hc5OJQJh 8hcOJQJh 8hF)OJQJ%6 7 Z [ =-- t"d$Ifgdkd$$Ifl\G5&G_ GH  t05&64lalp[ \ ] p q yiii\iL t"d$Ifgd t"M]Mgd? t"d]gd6kd$$Ifl05&A  t 05&64lalp   t"d$Ifgd t"d$If]gd =--- t"d]gd6kdO$$Ifl\jK 5&  t05&64lalpJKvҿҿҴtdTdE9h 8hm[5OJQJh 8hm[CJ OJQJaJ h 8hLG5CJOJQJaJh 8hm[5CJOJQJaJh 8h_TOJQJh 8h5OJQJh 8hUCJOJQJaJh 8h1%=OJQJh 8hUCJ OJQJaJ h 8hF)OJQJhMYOJQJh 8hMYOJQJh 8hOJQJhnpOJQJjhnpOJQJUhw#hnp0JOJQJ^JgWGG d]gdm[ t"d]gd6hkdF$$IflS&S& t0S&64lalytnp t"d$Ifgd6WE t"d]gdU t"d]gde$%,3"ЄЄynncncncnh 8hAtOJQJh 8haOJQJh 8hvrOJQJh 8hUOJQJh 8hOJQJh 8hCJ OJQJaJ h 8h5OJQJh 8hU5OJQJh 8h1%=CJOJQJaJh 8hOJQJh 8hq3OJQJh 8h1%=OJQJh 8hm[CJ OJQJaJ $ t"d$Ifgd; t"d$If]gdq3 t"d]gdm[:*** t"d$Ifgd;kd$$Ifl\Ty5&: %  t05&64lalpytD>*kd$$Ifl\ g 5& E  t05&64lalpyt> t"d$Ifgd;*kd$$Ifl\(%g5&(B  t05&64lalpyt1%= t"d$Ifgd;$%#$%&'FGjZZZ t"d]gdehkd$$Ifl5&5& t05&64lalytCe $Ifgd1%= t"d]gd t"d]gd6 "#$%&'/:EFGadegmnt}#0ʺ}rrrfVh 8h5CJOJQJaJh 8h5OJQJh 8hOJQJhu1BOJQJh 8heOJQJh 8hsOJQJh 8hCJ OJQJaJ h 8he5CJOJQJaJh 8hs5CJOJQJaJh 8h:]5CJOJQJaJh 8h1%=5OJQJh 8hUCJ OJQJaJ h 8hF)OJQJG01jZJ t"d]gd:] t"d]gd1%=hkdU $$Iflh5&5& t05&64lalyt 8 $Ifgde t"d]gd t"d]gde01EF23n  ijkn+ȽzzzzznbnQn jh 8h5OJQJUh 8hAt5OJQJh 8h5OJQJh 8h:]OJQJh 8h:]5OJQJh 8h:]5>*OJQJh 8hOJQJh 8hXOJQJh 8OJQJh 8hUOJQJh 8hU5OJQJh 8hUCJ OJQJaJ h 8hU5>*OJQJh 8h:]CJ OJQJaJ 1EF23  jk t"d]gdg t"d]gd:] t"d]gdU+,-MN]^ۿ|plfb^hdshe h`CCJh`ChD4h`C<OJQJ h`C<jh`CUmHnHuhjhUh 8hAt5OJQJh 8h5OJQJh 8h5OJQJh 8he5OJQJh 8h0J5OJQJ^J jh 8h5OJQJU&j h 8h5OJQJU{ t"d]gdgdgd`Cgd`Cdgd`CHkd $$If30%%4a d$Ifgd`C $Ifgd`C h 8h5OJQJhdsh`C%hlh`CB*CJOJQJaJph%h0Jh`CB*CJOJQJaJphC 0P&P 1h:pX!. 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