Application Form 2018-2019

Please find the application form for the Certificate in Education and Training programme at the Centre for Lifelong Learning, University of Warwick. Once completed, click the ‘send form’ button at the bottom of the page to submit your application. If you have any questions concerning this process, please refer to the FAQs and/or contact us using the get ‘Get in Touch’ button, both found on the right side of this page.

Title *

Surname *

First Name *

Date of Birth

Gender *

Male

Female

Prefer not to say

Other

Nationality *

Email Address *

Phone Number *

Address line 1 *

Address line 2 *

Town or city *

County *

Postcode *

Country *

Employers Name

Are you still employed by this company *

Yes

Dates of Employment: (start)

Dates of Employment: (end)

Employers Address

Numbers of years teaching experience (a minimum of 30 hours is required over 1 year) *

If under one year please state the months/days here

Context for Previous Teaching (tick all that apply)

FE College

Sixth Form

Adult Education

Voluntary/Community

Work-based Learning

Secure Estate (e.g. Prisons)

Other

Level of Learners Taught (tick all that apply)

Pre-entry

Entry

Level 1

Level 2

Level 3

Other

Age of Learners Taught (tick all that apply)

14-16

16-18

19+

Other

Number of teaching practice hours over duration of the course (a minimum of 100 hours is required over 2 years)

Full Name of Manager who is supporting teaching practice hours

The University of Warwick and its partner colleges are committed to a policy of equal opportunities and will not discriminate against any applicant or student on the basis of age, gender, nationality, ethnicity or religion. Please help us to make our equal opportunities policy more effective by ticking the boxes below.

Do you have a disability *

Yes

Prefer not to say

Other

If yes please state the nature of disability

ASPERGERS – You have a social/communication impairment

VISUAL – You are blind or have serious visual impairment

HEARING – You are deaf or have a serious hearing impairment

UNSEEN – You have a long standing illness or condition

MENTAL HEALTH – You have a mental health condition

SPECIFIC LEARN DIFF – You have a specific learning difficulty

MOBILITY – You have physical impairment or mobility issues

OTHER – Condition not listed

MULTIPLE – You have two or more impairments and /or conditions

Your college will ask you to write personal statement approx. 500 words covering the following areas. Your reasons for undertaking this course. How studying for this qualification will relate to your interests and/or work. Any reading or training you have undertaken in relation to this course. Your interests and hobbies.

Personal Statement

You can also attach your personal statement here

Attach file

No files are currently attached.

Please state your highest qualification in English/Literacy

What grade was this achieved at

Please state your highest qualification in Maths/Numeracy

What grade was this achieved at (maths)

Please state your overall highest qualification

Please specify the subject that you have achieved your highest qualification in (e.g HND in Health and Social Care Distinction).

Please specify the subject that you will be teaching.

Please specify below who will be mentoring you on your programme: (Full Name)

Please specify the email address of who will be mentoring you on your programme.

Please specify the specialism of your subject mentor

Please specify the highest specific subject qualification you have if different from your answer to (As a reminder teachers should have at least a Level 3 qualification in the subject that they teach)

Please specify the institution that you attended to complete your highest subject specific qualification.

Please specify the Secondary School you attended.

Declaration of Criminal Record
It is a course requirement that the college and the University are made aware of any criminal convictions that you may have. If you have a criminal record, the college and the University will still consider you for a place on the course, but depending upon the nature of the offence/conviction the College and the University may give further consideration to your admission before confirming any offer. It’s therefore a requirement that the nominee at your place of employment completes the DBS (previously CRB) Waiver form. This will be forwarded to you upon offering you a place on the course.
If your conviction involved an offence similar to those set out above but was made by a court outside of Great Britain and that conviction would not be considered as spent under the Rehabilitation of Offenders Act 1974 you should tick the box.

Relevant criminal offences include convictions, cautions, admonitions, reprimands, final warnings, bind over offers or similar involving one or more of the following:

• Any kind of violence including (but not limited to) threatening behaviour, offences concerning the intention to harm or offences which resulted in actual bodily harm.
• Offences listed in the Sex Offences Act 2003.
• The unlawful supply of controlled drugs or substances where the conviction concerns commercial drug dealing or trafficking.
• Offences involving firearms.
• Offences involving arson.
• Offences listed in the Terrorism Act 2006.

If your conviction involved an offence similar to those set out above, but was made by a court outside of Great Britain, and that conviction would not be considered as spent under the Rehabilitation of Offenders Act 1974, you should tick the box

Do you have any criminal convictions *

Yes

Signature: (please type name) *

Date of signature *

Please find the Data Protection Statement at the bottom of this webpage, this will pop up in a separate window. Please ensure you read this carefully before confirming you have read and understood the Data Protection Statement.

I have read and understood the attached Data Protection Statement (please find link at bottom of page) *

Yes

If you wish to opt out of the National Student Survey ( Final Year students only)

Opt out

No action

I give permission for my Personal Information to be passed to the following bodies *

Partners (tutors and mentors)

Ofsted

Do you give permission for your Personal Information to be passed to the following bodies (please tick to confirm - must be ticked to proceed) *

Careers Service

Students Union

Research

Development and Alumni Relations Office

To conform with relevant legislation you must email studentrecords@warwick.ac.uk if you wish to opt out of taking part in the National Student Survey

I undertake to observe the Charters, Statutes, Ordinances and Regulations (the “Rules”) of the University and to submit to their discipline during such time as I am a registered student of the University. I confirm that I am aware of the scale of the fees and charges relating to my course of study and that I am in a position to meet such charges on the due dates of payment. I recognise that my registration as a student is subject to satisfactory academic progress in my course of study and is to be completed only on full payment of all outstanding fees and other sums due to the University. I understand that should my sponsor at any time fail to pay my fees and charges that are due, I will be personally liable for them.

Note: Registration is in accordance with the terms of the offer made by the University. A registration is not valid unless fees are paid or full details of sponsors are provided. If you fail to return this form by the notified date, your University card will be invalidated. I confirm that I have read and understood the Data Protection notice, Data Protection Guidelines, Declaration and the Rules and agree to be bound by them.

Signature: (please type name here) *

Full name: *

Date of signature. *

* indicates a required field

Privacy statement

This form will be used to manage an application for a course. Your details will be kept on file to administer the course. Your details and the data will be used to inform you of future courses but will not be passed to any third parties.

Please find a copy of our Data Protection Statement. Please ensure you read this carefully before confirming you have read and understood the Data Protection Statement.

By signing this document you are entering into a legal agreement with the University

Get in Touch

FAQ's

Data Protection Statement