APC Route 1+ is for applicants who;
  • hold an SpLD qualification at Post-graduate AMBDA Level gained
more than five years ago
  • gained AMBDA more than 5 years ago
  • are Professional Members of the British Dyslexia Association

Applicant Details (Please Print)
Title Forename(s): / Surname:
Current Address:
Postcode: / Email Address:
Telephone No: / Mobile No:
Do you have BDA Professional Membership?
If not you must apply with this application / Membership number:
M0…
AMBDA Certificate Number & Date Awarded / AMBDA FE/HE Certificate Number &
Date Awarded:
Have you submitted BDA CPD within the last three years? / Valid dates on certificate
  1. BDA AMBDA Level Accredited Course (Or Equivalent)

Course Title:
/ Institution/Provider:
Tutor(s) if known:
Start Date: / End Date:
  1. Education/Professional Qualification

Detail your initialteaching qualification or other appropriate specialist qualification

Professional Qualification:
Training Institution/University:
Start Date: / End Date:
  1. Certificate

Please indicate how you would like your name to appear on your Assessment Practising Certificate (APC).

  1. SASC List of Assessment Practising Certificate (APC) Holders

SASC charge a mandatory fee of £15 for listingAPC holders on the SASC website, this is included in the APC fee. The information listed currently includes: full name, APC number, awarding organisation, start date and expiry date.

  1. Permission to share details with SASC

To activate SASC associate membership, SASC requires your contact details to be provided by your APC issuing body, name, email and address]. This contact information will be shared with SASC for the purposes of

1activating Associate Membership of SASC

2SASC providing communication to the APC holder

These details will only be used by SASC for the purposes of SASC membership activities and communications. The publicly available information remains limited to name, certificate number, issue date and expiry date.

Consent declaration - please select your preference

□I consent to you sharing my personal information with SASC to activate my SASC Associate Membership as follows: Name, email, address

□ I wish to activate my SASC Associate Membership and agree to share my details with SASC as follows: Name, email, address, but do not wish to receive any communication from SASC

□ I wish to opt out of SASC Associate Membership. Do not share my details with SASC.

Data Protection

By completing this form, you are agreeing for us to administer your BDA Professional Membership and where necessary share your information internally within the BDA.

From time to time we may like to send you information about our own products and services that you might be interested in, by post, telephone, email and SMS. We will not pass your information on to any organisation external to the BDA.

If you agree to being contacted in this way, please tick the relevant boxes to indicate how you would like to be contacted:

Email SMSPost Telephone

The BDA is committed to protecting your personal data please see our Privacy Policy on our website at:

  1. Declaration: Please tick each box as appropriate, sign and date.

I confirm that the information provided is true and accurate
I agree to abide by the BDA Code of Ethics and Conduct
I agree to maintain and submit a CPD Portfolio every three years and understand that this is a condition of renewal
I am a BDA Professional Member and recognise that my APC is only valid as long as I maintain this membership; OR
I am applying forBDA Professional Membershipand recognise that my APC is only valid as long as I maintain this membership
I agree to pay £240 fee and understand that this is non- refundable and that If I have to resubmit a second report there is a remarking fee of £110 payable
The submitted diagnostic report is my own work and has not been submitted to any other APC awarding organisation
I enclose copies of any relevant documents and recognise that these are non-returnable but that I may be asked for originals. Original documents will be returned.
I understand that my submission may be used anonymously for training and moderation purposes within and between issuing and awarding bodies.
Signed / Date

CHECKLIST

 APC R1+ application form (this form)
 Diagnostic Assessment Report (anonymised)
 CPD log
 Up-to-date CV
 2 Professional References from suitably qualified professionals, on headed paper, signed by hand
 Payment of £240, see options below
 Two copies of alldocuments
Send your application for APC R1+ to:
Accreditation, British Dyslexia Association, 6a Bracknell Beeches, Bracknell Lane West,
Bracknell RG12 7BW
Please make sure you use the correct postage,the Post Office will not deliver underpaid items

Payment Options

Please note that payment is processed on receipt of application but does not imply that accreditation has been awarded
Cheques: Made payable to British Dyslexia Association, send with application
Bank transfers: British Dyslexia Association Sort Code: 20-71-06 Account : 90286141
International: IBAN GB05 BARC 2071 0690 2861 41/SWIFTBIC BARCGB22
Reference: APCR1+your name
Credit/debitcards: complete the credit card form and include with this application

Credit Card Form APC R1plus

Credit/Debit Card Payments

£ / 240.00

Please debit my account for the amount

£ / 2.50

(Plus £2.50 admin fee)

£ / 242.50

Total

Card number:

X / X / X

Security No Expiry Date:

Name as it appears on the card

Cardholder’s signature Date

Please note that payment will be taken on receipt of application

If you require a receipt, provide an email address below:

November 2017 APC R1+ BDA Registered Charity No. 289243 Limited Company: No. 1830587