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?
(please checkONLY ONE box) / Were you introduced or helped by an agent?
☐ Myself / ☐ Yes☐ No
☐ My sponsor
Sponsor’s Name:
Please send proof of sponsorship with your application / Agent’s name:
Agent’s email:

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.
☐ I have an unconditional offer to study at The University of Sheffield after my language course. I require a combined CAS for both courses.
☐ 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 Studyvisa (maximum 11 months)

For information on visas please see

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 – How long do I need to study? – Please refer to the recommendedEntry Levelson our website.

Please check  which course you would like to apply for

Long Term Pre-sessional English

Start Date ▼ / End Date ▼
2016-17 / Term 2 – 01/04/17
11 weeks / Term 3 – 10/06/17
7 weeks / Term 4 – 02/09/17
10 weeks / 2017-18 / Term 1 – 16/12/18
12 weeks / Term 2 – 24/03/18
10 weeks / Term 3 – 09/06/18
8 weeks
2016-17
Term 2 – 16/01/17 / 11 weeks £3135 / ☐ / 18 weeks £5130 / ☐ / 28 weeks £7980 / ☐ / 40 weeks £11400 / ☐
Term 3 – 24/04/17 / 7 weeks £1995 / ☐ / See ISS Below / 29 weeks £8265 / ☐ / 39 weeks £11115 / ☐
Term 4 – 26/06/17 / See ISS Below / 22 weeks £6270 / ☐ / 32 weeks £9120 / ☐ / 40 weeks £11400 / ☐
2017-18
Term 1 – 25/09/17 / 12 weeks £TBC / ☐ / 22 weeks £TBC / ☐ / 30 weeks £TBC / ☐
Term 2 – 15/01/18 / 10 weeks £TBC / ☐ / 18 weeks £TBC / ☐

Note: Tuition Fees for courses beginning in 2016-17 are £285 per week. Fees for 2017-18 are to be confirmed.

ISS – International Summer School 2017 – Pre-sessional English

Course / Dates / Study Weeks / Fees
☐ / 17 Week Programme / 24 April - 2 September 2017
(Includes 2 week vacation: 12 - 24 June 2017) / 17 / £4845
☐ / 10 Week Programme / 26 June - 2 September 2017 / 10 / £2850
☐ / 6 Week Programme / 24 July - 2 September 2017 / 6 / £1710
☐ / 4 Week Programme / 7 August - 2 September 2017 / 4 / £1140

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:

ELTCentre, The University of Sheffield, 78 Hoyle Street, Sheffield, S3 7LG, UK

Telephone: +44 114 222 1780e-mail: