Application for Student Led Interruption to Study
Taught Students / Date form received by CAS Hub: / Academic Registry
Rev –
July 18
What is course interruption?
  • Students who want to take a break away from their studies must apply for an Interruption. This means that a student does not formally engage with their course and must not attend class nor submit work for assessment or attend examinations.

  • The grounds on which an application to interrupt study can be authorised are set out in the policies

  • Before you Interrupt, visit The <i> for information and guidance concerning financial implications regarding your Tuition Fees. You are also advised to seek advice concerning accommodation, benefits and funding from The SU Advice Centre and if applicable, from your sponsor.

How do I apply to interrupt my studies?
  1. Complete Section 1 with your details, seek guidance on the application process from The <i>, your CAS Hub or your Academic Advisor.

  1. If you are a Tier 4 International Student you must take this form to The <i> to book an <i> appointment to receive confirmation of agreement for your interruption to study

  1. Arrange to meet with your Course Leader taking this form and any supporting evidence along with you

  1. Once signed by your Course Leader read through the declaration in Section 4, sign the form and submit it immediately to a CAS Hubfor approval along with any appropriate supporting documentary evidence within 2 working days of your meeting with your Course Leader

Note: The above steps can be undertaken electronically and the Course Leader meetng could take place via Skype or Telephone.
Section 1: Your details / For student completion only
Surname: / First Name(s):
Rgistration No : / Partner Institution / Campus:
Date of Birth: / Click or tap to enter a date. / Please indicate if you are:
Home: ☐EU: ☐Overseas/International: ☐
Course Name: / Year of Course:
e.g. Year 2
New Expected Completion date: / Original duration:
e.g. 3
Section 1: Your details / For student completion only
Surname: / First Name(s):
Registration Number: / School:
Date of Birth: / DD/MM/YYYY / Please indicate if you are:
Home: ☐EU: ☐Overseas/International: ☐
Course Name: / Year of Course:
e.g. Year 2
Original duration: e.g. 3 Years / Course start date if Non-Standard: / DD/MM/YYYY
New Expected Completion date: / DD/MM/YYYY / DD/MM/YYYY
Mode of Attendance: Full-Time: ☐Part Time: ☐Sandwich: ☐Distance Learning: ☐
Reason(s) for Interrupting your Study: Health: ☐Academic: ☐Other: ☐
I am submitting evidence to support my application: Yes: ☐No: ☐
I am a sponsored student: Yes: ☐No: ☐
Further Details (to be given to Student Loan Company in support of your Interruption):
Years / Course start date if Non-Standard:
Mode of Attendance: Full-Time: ☐Part Time: ☐Sandwich: ☐Distance Learning: ☐
Reason(s) for Interrupting your Study: Health: ☐Academic: ☐Other: ☐
I am submitting evidence to support my application: Yes: ☐ No: ☐ / I am a sponsored student: Yes: ☐ No: ☐
Any further Details (to be given to Student Loan Company in support of your Interruption):
Please provide the detail in support of your request on a separate sheet titled: Confidential Statement in support of application
Section 2: Tier 4 International Students Only
Confirmation is given that the above-named Student has received advice from The <i> in relation to their request to interrupt their studies and the student Starfish Notes record has been updated.
  1. For Tier 4 International Students, Interruption to Study will mean students are required to leave the UK during the period of interruption and re-apply for a Confirmation of Acceptance of Study (CAS) to return to study.
  2. Students must reapply, in their home country for a new visa to reflect the new expected programme completion date and to check for immigration updates in planning their return.
/ STAMP
Date: / Click or tap to enter a date. /
Section 3: Course Leader Academic Approval / For Course Leader completion only
Interruption Start Date: /
  1. This is the date of the meeting with the Course Leader
  2. Retrospective interruptions are not normally permitted, seek guidance from SRMT.
/ Click or tap to enter a date. /
I approve this Student’s interruption to study☐ / Agreed date of resumption: / Click or tap to enter a date. /
Detail of any conditions to be met in advance of return:
Note: Students are not permitted to undertake any study/assessment during the period of interruption / With electronic completion, this is an expandable text field
I do not approve this interruption for the reasons outlined below ☐ / With electronic completion, this is an expandable text field
Print Name: / Signed: / Date: / Click or tap to enter a date. /
Section 4: Student Declaration / For student completion only
  • I note that interrupting my course of study at UCLan may affect my eligibility for full-time or part-time financial support, the funding package for which I am eligible and the tuition fees charged and that it is recommended that I seek advice from the UCLan Student Union regarding the wider financial implications.

  • I am aware that all guidance is provided in good faith based on the information held about my situation. I note that UCLan endeavours to ensure that guidance is accurate at the time it was given. However, it can be subject to change and responsibility cannot be accepted for any errors or omissions, for consequences arising from the use of the information, nor for decisions or updates made by government agencies. Should any information change, any guidance that I have already been given may no longer be applicable and I may be required to revisit The <i>.

  • In signing this form I confirm that I have investigated my circumstances in light of the changes requested above and understand the impact upon my academic studies.

Signed: / Date: / Click or tap to enter a date. /
Please now submit this form along with any appropriate supporting documentary evidence to your CAS Hub.
Section 5: Return to Study meeting with Course Leader or Head of School
Date of Welcome back meeting: / Click or tap to enter a date. / Confirmation conditions met / Yes: ☐No: ☐
Print Name: / Signed:
Section 6: Notification of Student Interruption / For CAS Hub completion only
Student Support No: / UCAS Code: (if known)
Reported all International student interruptions to SICT () for UKVI reporting purposes? / Yes No
Reported when students who have declared a disability interrupt () or where an interruption is related to wellbeing or welfare matters ( ) / Yes No
For NHS commissioned courses: NHS Business Services Unit informed through submission of BUR101W (MAT)? / Yes No
If appropriate, has the Accommodation Office been informed ()? / Yes No
If appropriate, has the Research Council, Business Partner Unit and/or Sponsor been informed? / Yes No
CAS Hub Declaration: I confirm that I have processed the above Interruption to study as detailed, updated the Banner Student Record system as appropriate, sent this form tocopying in the Head of School and other appropriate teams as detailed above.
Name: / Date: / Position:
1 Fee adjustment details: / 2 Portal: / 3 Other Comment: / For SFFT completion only
Original Fee: / Revised Fee: / Pending
Submitted /
Comments:
Staff initials and date / Staff initials and date / Staff initials and date