Access to Leeds 2015 Application Form

Website: www.leeds.ac.uk/A2L

Email: accesstoleeds@leeds.ac.uk

Sections 1 to 4 should be completed by the applicant, sections 5 to 7 should be completed by a referee

from the applicants school/college.
Guidance on completing this application is available from: www.leeds.ac.uk/A2L
The deadlines for applications to the scheme are: 7th November 2014 for applicants to Medicine and
Dentistry degree programmes and 27th February 2015 for applicants to all other degree programmes.
Please return your completed form to:
Access to Leeds, Educational Engagement, University of Leeds, Leeds, LS2 9JT

1. Personal Details - you must complete all parts of this section

UCAS Personal ID

This can be found on your UCAS application/Track accou nt

Title

Address

First name
Last name
Preferred name

Postcode

Date of birth

Mobile phone

Male/Female

Home phone

Email

We will send correspondence via email

Name of the school you completed your GCSEs (or equivalent) at?

2. About the Scheme - you must complete all of this section

How did you hear about the scheme?

Have you participated in any of the following?

Teacher or tutor

Reach for Excellence

Access to Leeds presentation

Realising Opportunities

University website

Tutoring/mentoring from University of Leeds students

UCAS event

Are you a re-applicant to the scheme?

University prospectus

Friend or sibling

University of Leeds Open Day

If you have applied to this scheme before, please DO NOT

complete this form and contact the Access to Leeds team at
accesstoleeds@leeds.ac.uk.

Yes

No

3. Course Details - you must complete this section including ALL courses applied for at the University

of Leeds
Course(s) applied for

Course Code(s)

4. Applicants Statement & Declaration

Please provide details of how you meet the eligibility criteria and why you would like to study at the
University of Leeds. Please continue on a separate sheet if required.
Please refer to the Application Guidelines for help in completing this section.

I confirm that the information provided on this form is true, complete and accurate and no information requested
has been omitted. I give my consent to the processing of my data by the University of Leeds and to contact my
referee for additional information if required.
Applicants
signature

Date

Applicant Checklist
Please ensure the following:

I have included my UCAS personal ID number in the first section of this form.
I live permanently in the UK, and my address on my form matches that on my UCAS application.
I have listed all of the courses I am applying to, and am not applying solely to a Foundation Degree.
My parent/ guardian has completed the additional Parental Declaration Form (where your eligibility for
criterion ii. Low household income is confirmed by parent or guardian).
I have completed the applicant statement and have signed the applicant declaration (above).
I have provided a correct and up to date email address and will inform the Access to Leeds team of any
changes to my contact details.

You should now ask your referee to complete the remaining sections of the form.
Please note that incomplete applications will be returned to either you or your referee and this will
delay the processing of your application to Access to Leeds.

The remaining sections of this form are to be completed by a referee from the applicants
school or college
5. Referees Details - this section must be completed by a tutor or teacher

School/ College
Name

Telephone

Job title

Email

6. Referees Statement

Please provide details of why you believe the applicant to be eligible for the scheme. Please refer to the
Application Guidelines for help on completing this section. If you continue onto a second page please
ensure this is signed.

Referee section continues on next page

7. Eligibility Criteria

Please tick which criteria the applicant meets and sign the declaration. Please refer to the Application
Guidelines for help in completing this section.
i.

ii.

This applicant is from a household with gross annual income of 25000 or below. The applicant
demonstrates their eligibility for this criterion in one of the following ways:

This applicant is in the first generation of their immediate family to apply to higher education

This applicant is in receipt of 16-19 Bursary fund or Learner Discretionary Support with income
threshold of 25000 or below
This applicant was in receipt of free school meals during their GCSE studies OR
This applicants gross household income is of 25,000 or below and is confirmed with an enclosed
Declaration of Household Income form completed by the applicants parent or guardian.
iii.

This applicant attended a school which achieved below the national average of 5 A* to C passes at
GCSE (including Maths and English)

iv.

v.

This applicants studies have been disrupted or adversely affected by circumstances in their personal,
social or domestic lives

vi.

This applicants only higher education option is to attend a local university (please enclose a full copy of
the applicants UCAS form)

vii.

This applicant is currently living in or grew up in public care

This applicant lives in a geographical area with low levels of progression on to higher education

The information given on this form is complete and accurate, to the best of my knowledge and belief, and gives a
true description of the applicants personal circumstances. I agree that the University of Leeds may make any
reasonable enquiries in connection with this application.
Referees Signature

Date

Referee Checklist
Please ensure you have completed the following:

I have fully completed the referee details section.

I have completed a reference and confirmed which eligibility criteria the applicant meets.
I have signed the referee declaration (above).
I have signed any additional pages used for my reference.

Please note that incomplete applications will be returned to either yourself or the applicant and this will
delay the processing of the application to Access to Leeds.

Any queries regarding the Access to Leeds application form, or the scheme in general, should be
directed to us via email to accesstoleeds@leeds.ac.uk.

Access to Leeds 2015 Guidelines for Application

The applicant needs to complete sections 1, 2, 3 and 4 of the Access to Leeds 2015
application form. Teachers, tutors or careers advisers must complete sections 5, 6 and 7.
Details on how to complete the form are included on page 5 of this document. Information
on the eligibility criteria can be found below.
Please note that all information included in the Access to Leeds form will be treated as
strictly confidential and will only be shared with staff relevant to the admissions process,
where necessary.

Access to Leeds Eligibility Criteria

To be eligible for the scheme, applicants must:

Be applying via UCAS to a full time undergraduate course at the University of

Leeds
Be living permanently in the UK (UK home addresses only)
Have no previous experience of higher education
Must not have previously completed a foundation degree or Access to HE course
Have the potential to succeed at the University of Leeds

In addition, applicants must meet at least two of the following eligibility criteria:

First generation of immediate family to apply to higher education

Any applicant whose parents have not previously completed a higher education
course is eligible for this criterion.
This criterion is not affected by parents of applicants that have started but not
completed a higher education course, studied for Open University degrees or
undertaken higher education courses during the applicants secondary education
(Year 7 onwards).
Applicants with siblings who have completed a higher education course or who are
presently going through higher education are still eligible for this criterion (as long
as their parents have not undertaken a higher education course). This criterion is
also not affected by family members outside of the immediate family such as
grandparents, cousins, uncles and aunts.

Higher education courses include degrees and masters courses, usually

undertaken at university. If you are unsure whether a qualification completed by
the parent of a student is classed as a higher education course, please contact the
Access to Leeds team (contact details on final page).

From a household with a gross annual income of 25,000 or below

Applicants who meet this criterion should have a gross household income of
25,000 or below. Applicants can demonstrate their eligibility for this criterion in
one of three ways:
1. In receipt of Free School Meals (FSM) during their GCSE or A Level studies.
(A referee from the applicants school or college can confirm the applicant was
in receipt of FSM during their GCSE or A Level studies)
2. In receipt of 16-19 Bursary Fund or Discretionary Learner Support with income
threshold of 25,000 or below (A referee from the applicants school or college
can confirm the applicant was in receipt of this during their GCSE studies)
3. Applicants that are not in receipt of FSM, Bursary Fund or Discretionary
Learner Support can demonstrate their eligibility for this criterion by submitting
a Declaration of Household Income, completed by their parent(s) or
guardian(s). A Declaration of Household Income and guidelines for completing
the form can be downloaded from www.leeds.ac.uk/A2L (contact the Access to
Leeds team if you live independently without a parent or guardian to confirm
your household income).

Attended or attends a school which achieved less than the national average
of 5 A* to C passes (including English & Maths) at GCSE
If a school achieved a GCSE pass rate of less than the national average of 5 A* to
C passes (including English & Maths) any applicant from that school will be eligible
for this criterion.
The applicant is also eligible for this criterion if they attended years 10 or 11 or took
their GCSE exams at a school which achieved a GCSE pass rate of less than the
national average of 5 A* to C passes (including English & Maths).
Applicants should use the GCSE pass rate and national average for the year in
which they sat their exams. The national average of 5 A* to C passes (including
English & Maths) for 2013 was 59.2%.
School performance tables can be found on the Department for Education website
at www.education.gov.uk/schools/performance

Currently living in or grew up in public care

To be eligible for this criterion, you should have grown up in or currently be living in
public care for any length of time (during secondary school).

Studies disrupted or adversely affected by circumstances in their personal,

social or domestic life
Applicants meet this criterion if their studies have been disrupted by circumstances
beyond their control. Each application is considered on an individual basis and we
cannot provide an exhaustive list of circumstances that meet this criterion. We are
however willing to consider any circumstances that a teacher or tutor can verify as
having a detrimental impact on a students studies.
You must provide further details of these circumstances in BOTH the applicants
and referees statements on the application form. Any information provided will be
treated with the strictest confidence. If details of the applicants circumstances are
not included in the referees statement, we will be unable to process the application
until further information has been obtained.

Only higher education option is to attend a local university

To be eligible for this criterion attending a local university must be the applicants
only Higher Education option and not simply a preferred option. We cannot accept
financial reasons for having to attend a local Higher Education institution as
financial circumstances are considered as a part of the household income criterion.
Each application is considered on an individual basis and we cannot provide an
exhaustive list of circumstances that meet this criterion.
A copy of the applicants full UCAS form showing all choices of institutions must be
provided in order for your eligibility for the criterion to be assessed. Local
institutions are deemed as those which are approximately 1.5 hours from your
home area via public transport. This will be assessed on a case by case basis.
Please contact the Access to Leeds team for further guidance.
You must provide further details of the applicants circumstances in the referees
statement. Any information provided will be treated with the strictest confidence. If
details of the applicants circumstances are not included in the referees statement,
we will be unable to process the application until further information has been
obtained.

Living in a geographical area with low levels of progression on to higher

education
We determine which geographical areas have a low level of progression onto
higher education using the applicants home postcode and measuring this against
data provided by the government. The data we use to judge eligibility is provided
annually by UCAS and the University of Leeds has no influence over those areas
which are and are not, deemed eligible.
To see if an applicant meets this criterion please visit
http://srmt.leeds.ac.uk/a2lpostcodesearch.php where applicants can input their
postcodes to see if they are eligible.
If you require any further information please do not hesitate to contact the Access
to Leeds team (contact details on the final page).

Completing the Form Sections 1 4 (for applicants)

To apply for the Access to Leeds scheme the applicant must complete sections 1, 2, 3
and 4 of the Access to Leeds 2015 application form. Please ensure that a tutor completes
sections 5, 6, 7 and 8.

Section 1: Personal Details

UCAS Number: You must include your ten digit UCAS Personal Identification number.
This is the number we will use when tracking your application.
Email address: Please include a valid email address. Most of the correspondence from
the Access to Leeds team will be via email.
Please ensure you inform the Access to Leeds team if your email or postal address
change so that we can keep you updated on the progress of your application. If Access to
Leeds are not informed of any changes we cannot take any responsibility for applicants
not receiving important information regarding their application.
Preferred Name: You may also wish to specify a Preferred Name that we will use when
contacting you; for example this may be your middle name.
Disability or Medical Condition: Please include details of any disability or medical
condition you have. This section is not compulsory, but if you require extra support when
attending events on the University campus please let us know.

Section 2: How did you hear about the scheme?

Please use this section to let us know how you first heard about the Access to Leeds
scheme and if you have participated in other activities at the University of Leeds, such as
the Reach for Excellence scheme.
This section is not compulsory but this information is very important to us as it helps us to
assess the success of the Access to Leeds scheme.
If you are a re-applicant to the scheme please contact the Access to Leeds team for
guidance.

Section 3: Course Details

Please give details of the course(s) you are applying for at the University of Leeds,
including the UCAS course code.
Please note - You must apply for your course through UCAS in the normal way. The
Access to Leeds application should be made in addition to your UCAS application. You
do not have to declare you are applying to the Access to Leeds scheme on your UCAS
application.

Section 4: Applicant Statement

In this section please provide some information about yourself. As we receive a copy of
your UCAS application and personal statement you do not need to include the information
provided on your UCAS form.
You may wish to write about why you want to study the course you have chosen, why you
want to come to the University of Leeds and why you feel you meet the Access to Leeds
criteria. Please also include any further information about yourself which you consider to
be relevant and why you feel you would benefit from the Access to Leeds scheme.
If your studies have been disrupted or if your only higher education option is to attend a
local university, you must provide additional details of this in the applicant statement.
Please sign to confirm that the information provided is, to the best of your
knowledge, true, complete and accurate.

Completing the Form Sections 5 7 (for referees)

A teacher, tutor or careers advisor must complete sections 5, 6, 7 and 8.
Section 5: Referees Details
Please give details of your name, job title, telephone number and e-mail address so
that the University can contact you if any additional information is required to support
the application.
Section 6: Referees Statement
Please write a statement in support of the students application. In this statement you
must confirm that the student has the potential to become a University of Leeds
student, and that they also meet the Access to Leeds criteria.
You must provide additional information regarding the applicants circumstances where
they meet the eligibility criterion for disrupted studies or attending a local university.
Please also include any further information you believe would support the students
application to the University of Leeds. Please provide as much detail as possible, as it
is important for admissions tutors to understand the full context of the students
application.
If required, please continue on a separate sheet and attach to the application.
Continuation sheets must be provided on headed paper. In addition, each sheet must
be signed by the referee and contain the applicants name and UCAS number.
Section 7: Eligibility Criteria
As a referee for the application, we need you to confirm the applicants eligibility for the
Access to Leeds scheme. Please tick the box next to each criterion you believe the
applicant meets. Guidelines on eligibility are included on page 1 of this document.

Once you have completed the application please sign the declaration at the
bottom of the form. We cannot accept applications without a signature from the
referee.

What Next?
Once the form is complete, the form should be sent to the address below.
Upon receipt of your application, we will assess your eligibility for the scheme and contact
the admissions tutors for the course you have applied to.
You will then receive an email which confirms your eligibility for the scheme. This email
will also provide details of your next steps.
The form should be returned to:
Access to Leeds Team
Educational Engagement
University of Leeds
Leeds
LS2 9JT

Deadlines
For applicants to Medicine and Dentistry, applications must be received by 7th
November, 2014.
For applicants to all other courses, applications must be received by 27th February,
2015.
Contact Details
Email: accesstoleeds@leeds.ac.uk
Telephone: 0113 343 8952