ࡱ> G _bjbj ii4&&8TDKY(DDDD---XXXXXXX$\_X-)-)-^--XDDY111-RD8DX1-X11QTD@?Hő-^R"XY0KYR5`7.5`DT5`T1---XXO/---KY----5`---------&X ~: Department for Lifelong Learning: U21 Disrupted Studies Form The Department for Lifelong Learning 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 the Department for Lifelong Learning aged under 21 to notify the University 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 Department for Lifelong Learning 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 for the DLL 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 University 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 University 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, 鶹ֱapp, Level 2, Arts Tower, Western Bank, Sheffield, S10 2TN      Admissions Service <=>@ U V \ t B E g h      ĸvkkk\jh 8h+/OJQJUh 8hcOJQJh 8hCJ OJQJaJ 2h 8hB*OJQJ^JfHphA@Bq h 8hOJQJh 8h5CJ OJQJh 8hOJQJ\h 8hF)OJQJh 8hc5CJ OJQJaJ h 8hF)5CJ OJQJaJ h 8h5CJ OJQJaJ $=>  t"d$If]gd t"d$Ifgd t"d$If]gd6 t"d]gd6 d]gd6 Ld]gd Ld]gd6 Z [ \     ) * + 0 3 > N O P ׽vg\\\\\\h 8hcOJQJh 8hF)CJ OJQJaJ h 8h65OJQJh 8hF)5OJQJh 8hcCJ OJQJaJ h 8hm[5CJOJQJaJh 8hc5CJOJQJaJh 8hF)OJQJh 8h+/0JOJQJ^Jjh 8h+/OJQJU#jh 8h 8OJQJUh 8OJQJ$ -kd$$Ifl\5&>   t05&64lalp t"d$Ifgd     ) * Ukd$$Ifl0a 5&a   t 05&64lalp  t"d$Ifgd t"d$If]gd* + N O =-- t"d$Ifgdkd$$Ifl\G5&G_ GH  t05&64lalpO P Q d e yiii\iL t"d$Ifgd t"M]Mgd? t"d]gd6kd$$Ifl05&A  t 05&64lalp P Q W X Y d e nopqrs·¡·xm^Rh 8h5OJQJh 8hUCJOJQJaJh 8h1%=OJQJh 8hUCJ OJQJaJ h 8hU5OJQJh 8hU5>*OJQJh 8hF)OJQJh 8h?OJQJh 8hOJQJh 8hF)CJ OJQJaJ h 8h65OJQJh 8hF)5OJQJh 8hc5OJQJh 8hcOJQJ  t"d$Ifgd t"d$If]gd =--- t"d]gd6kdO$$Ifl\jK 5&  t05&64lalp opqrsgWGG d]gdm[ t"d]gd6hkdF$$IflS&S& t0S&64lalyt t"d$Ifgd6WE t"d]gdU t"d]gde%&'/012HIJZ[\]no}~ƺƯ~rcXh 8hOJQJh 8hCJ OJQJaJ h 8h5OJQJh 8hU5OJQJh 8h1%=CJOJQJaJh 8hOJQJh 8hq3OJQJh 8h1%=OJQJh 8hm[5OJQJh 8hm[CJ OJQJaJ h 8hLG5CJOJQJaJh 8hm[5CJOJQJaJh 8h_TOJQJ"&'01 t"d$Ifgd; t"d$If]gdq3 t"d]gdm[12IJ[:*** t"d$Ifgd;kd$$Ifl\Ty5&: %  t05&64lalpytD>[\]no*kd$$Ifl\ g 5& E  t05&64lalpyt> t"d$Ifgd;o}~*kd$$Ifl\(%g5&(B  t05&64lalpyt1%= t"d$Ifgd;jZZZ t"d]gdehkd$$Ifl5&5& t05&64lalytCe $Ifgd1%= t"d]gd t"d]gd6 ./~ɾɾɾɳxhxYNNh 8hsOJQJh 8hCJ OJQJaJ h 8he5CJOJQJaJh 8hs5CJOJQJaJh 8h:]5CJOJQJaJh 8h1%=5OJQJh 8hUCJ OJQJaJ h 8hF)OJQJh 8hAtOJQJh 8haOJQJh 8hvrOJQJh 8hUOJQJh 8hOJQJh 8hOJQJ#@F !"aĴxlllaaaaaYYah 8OJQJh 8hUOJQJh 8hU5OJQJh 8hUCJ OJQJaJ h 8hU5>*OJQJh 8h:]CJ OJQJaJ h 8h:]5CJOJQJaJh 8h5CJOJQJaJh 8h5OJQJh 8hCJ OJQJaJ h 8hOJQJh 8hsOJQJh 8heOJQJ!jZJ t"d]gd:] t"d]gd1%=hkdU $$Iflh5&5& t05&64lalyt 8 $Ifgde t"d]gd t"d]gde!"bcyzWX4679:<= t"d]gdg t"d]gd:] t"d]gdUabcyzUVWX:VcdqaUh 8he5OJQJh 8h0J5OJQJ^J&j h 8h5OJQJU jh 8h5OJQJUh 8hAt5OJQJh 8h5OJQJh 8OJQJh 8h:]OJQJh 8h:]5OJQJh 8h:]CJ OJQJaJ h 8h:]5>*OJQJh 8hOJQJh 8hXOJQJ$3456789:;<=>?@ABCDEFGHIST[\]^_|%hlh`CB*CJOJQJaJph%h0Jh`CB*CJOJQJaJphhe h`CCJh`ChD4h`C<OJQJ h`C<jh`CUmHnHuh)jh)Uh 8hAt5OJQJh 8h5OJQJh 8h5OJQJ#=?@CDEGHIT\]^_{ t"d]gdgdgd`Cgd`Cdgd`CHkd $$If30%%4a d$Ifgd`C $Ifgd`C C 0P&P 1h:pX!. 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