University English Full-Time Application Form

Please read the course details and the Terms and Conditions carefully before you complete this form.
PERSONAL DETAILS – details & spelling must be the same as shown in your passport
Family name Nationality
First name(s) Country of birth
Other names Passport No
Sex (m/f) Email address
Date of birth* Telephone No
*Will you be at least 18 years of age at the start of your course? ☐Yes ☐No
*Do you have any disability or special needs you wish to tell us about? ☐Yes ☐No
If yes, give details (on a separate sheet.)

Permanent address Contact address (if different)

Address line 1 Address line 1
Address line 2 Address line 2
Address line 3 Address line 3
Town/city Town/city
Region Region
Country Country
Post code Post code

COURSE FEES AGENT

Who will pay your course fees? Were you introduced or helped by an agent?
(please check  ONLY ONE box)
☐ Myself ☐ Yes ☐ No
☐ My sponsor Agent’s name:
Sponsor’s Name: Agent’s email:
Please send proof of sponsorship with your application
Acceptable sponsors include universities, government agencies, charitable organisations and registered international companies

ENGLISH TEST SCORES - Please give details of your most recent English test:
Type of test
(e.g. IELTS for UKVI)
Test centre/school
Test date
Score
Please send a copy of your English test certificate with your application. If you require a Tier 4 visa you must provide an IELTS for
UKVI result. Academic IELTS cannot be used to obtain a Tier 4 visa.

VISA REQUIREMENTS – please check  ONLY ONE box

☐ I require a Confirmation of Acceptance for Studies (CAS) for a Tier 4 student visa for my English language
course only
☐ I do not need a visa to study in UK (e.g. EU nationals).
☐ I will apply for a dependant visa
☐ I will apply for a Short-Term Study visa (maximum 6 months)
☐ I will apply for an Extended Short-Term Study visa (maximum 11 months)
For information on visas please see http://www.sheffield.ac.uk/ssid/international/immigration

UNIVERSITY PLANS - If you will study at a British university after your English course, please give details:
University ☐ University of Sheffield ☐ Other:
Department
Course
Start date
Applicant No.
Offer status ☐ Unconditional ☐ Conditional ☐ Don’t know
English level required
PREVIOUS STUDY IN THE UK
Have you studied in the UK before? ☐ Yes ☐ No
Have you previously held a Tier 4 visa? ☐ Yes ☐ No
If you have studied in the UK before please include with your application:
 A copy of all previous study UK visas (Tier 4, Short-Term Study, Student Visitor Visas etc),
 A copy of all previous CAS statements (if you had a Tier 4 visa) or
 Information about the course and level, such as a letter confirming your attendance or a certificate.
This information is required by UK Visas & Immigration. If you do not provide this information we will not be able to issue a CAS.

COURSES

Long Term University English

Term 1 – Term 2 – Term 3 – Term 4 –

2018-19
2017-18

Term 4 – 01/09/18
End Date ► 15/12/18 06/04/19 08/06/19 31/08/19
10 weeks
12 weeks 12 weeks 6 weeks 10 weeks
Start Date ▼
2017-18
Term 4 – 10 weeks 22 weeks 34 weeks 40 weeks
☐ ☐ ☐ ☐
25/06/18 £2950 £6490 £10,030 £11,800
2018-19
Term 1 – 12 weeks 24 weeks 30 weeks 40 weeks
☐ ☐ ☐ ☐
24/09/18 £3660 £7320 £9150 £12200
Term 2 – 12 weeks 18 weeks 28 weeks
☐ ☐ ☐
14/01/19 £3660 £5490 £8540
Term 3 – 6 weeks 16 weeks
☐ ☐
29/04/19 £1830 £4880
Term 4 – 10 weeks
☐
24/06/19 £3050

Short Term University English (minimum duration 2 weeks)

Please enter your chosen start date and end date:
Start Date
End Date
You can start this course on any Monday and finish the course on any Friday during our standard term dates. If your
chosen course dates take place over multiple terms, you must apply to study for a minimum period of two weeks in
each term.

Tuition fees for courses starting in the 2017-18 academic year are £295 per week. Fees for courses starting in the 2018-
19 academic year are £305 per week.

ETHNICITY INFORMATION - Please specify which ethnicity you identify as:

White ☐ Asian or Asian British - Pakistani ☐ Mixed - White & Black African ☐
Black or Black British - Caribbean ☐ Asian or Asian British - Bangladeshi ☐ Mixed - White & Asian ☐
Black or Black British - African ☐ Chinese ☐ Mixed - Other Background ☐
Black - Other Background ☐ Asian - Other Background ☐ Other Ethnic Background ☐
Asian or Asian British - Indian ☐ Mixed - White & Black Caribbean ☐ Information withheld ☐

Declaration: I have read and understood the Terms and Conditions relating to this application, including the
advice on insurance.

Signature: ___________________________________________________ Date: _______________________

Please send this form, a copy of your passport photograph page and your English language certificate to:
English Language Teaching Centre, The University of Sheffield, 78 Hoyle Street, Sheffield, S3 7LG, UK

Telephone: +44 114 222 1780 e-mail: eltc@sheffield.ac.uk