Undergraduate Programmes Application Form

Undergraduate Programmes Application Form

SECTION1: Select programme(leave blank if you are uncertain which programme to apply for)

Please refer to guidelines for completing an application

Full-TimeHonours Degree (3 years) 
Preferred location for Sept 2015 year 1 students:
Medway, Kent  East London 
No preference 
BA(Hons) Youth Work and Community Learning and Development 
BA(Hons) Education and Learning (Youth Work and Community Learning and Development) 
BA (Hons) Social Pedagogy (Youth Work and Community Learning and Development)  / Distance Learning Honours Degree (4 years) 
Level 3 Diploma (Rank Foundation YAP students only) 
BA(Hons) Youth Work and Community Learning and Development  BA(Hons) Education and Learning (Youth Work and Community Learning and Development) 
BA (Hons) Social Pedagogy (Youth Work and Community Learning and Development) 

SECTION 2: PERSONAL DETAILS

Title and surname / First names (underline the name you are usually known by) / Date of birth
Previous surname (if applicable) / Nationality:
Do you require a Visa to study in the UK? YES/NO / National Insurance No.
Permanent address:
Postcode
Length of residence. years/months______ / Previous address:
Postcode
Length of residence. years/months______
Home telephone No: / Work telephone No:
Work fax number: / Please state how you heard about our courses
Newspaper 
Journal 
Collegewebsite 
Search engine 
Word of mouth 
Other 
Mobile number:
E-mail: / Work website:
Work email:
Who will pay your tuition fees?
Self-funding  Employer Please state ______
Local Authority  Please state ______Student Loan Company 
Other Please give details______Rank Foundation (YAP) 

SECTION 3: EMPLOYMENT DETAILS

Complete this section if you are currently employed in youth work ora related field.
Name and full address of organisation including postcode:
Line manager ______
Your job title ______When started(month/ year) ______
Full-time/part-time/voluntary (please underline) Number of hours worked per week______
Current responsibilities:
Please provide details of any relevant work history (paid or voluntary)
Dates
from to / Job title / Name and address of organisation / Reason for leaving
Other relevant experience
Please continue this section on a separate page if necessary

SECTION 4: EDUCATION: SECONDARY/FURTHER/HIGHER

Date
from to / Name of School/ College/University / Subjects/Course / Level / Date of results / Grade

Originals of relevant certificates will be required at interview

SECTION 5: RELEVANT TRAINING

Date
from to / Course title / Course provider / Length & /or number of sessions / Qualification/result

SECTION 6: ADDITIONALLEARNING SUPPORT

Do you have any additional learning support needs? No  Yes  If yes,please explainbelow
______
Are you dyslexic? No  Yes 
Are you applying for Disabled Student Allowance? Yes  No 

SECTION 7: HEALTH DETAILS and Emergency Contact Details

Do you consider yourself to have a disability? Yes  No
Are you registered disabled? Yes  No
(if yes, please provide details)
Are you at present receiving treatment for any unseen disabilities? Yes  No
(e.g. asthma, diabetes, epilepsy) If so, please provide details
Do you have any health issues that may affect your ability to undertake this programme? Yes  No
(If so, please provide details)
Please provide details of who you would like us to contact in the event of an emergency:
First Contact Name: Second contact Name:
Relationship to Student: Relationship to student:
Address: Address:
Landline Telephone No.: Landline Telephone no.:
Mobile Telephone No.: Mobile Telephone no.:
Email: Email:

SECTION 8: HOW DO I COMPLETE AN APPLICATION?

Please note that this application will not be considered unless all of the following have been completed:

1st reference (line manager)  Additional support section 

2nd reference  Health section 

Supporting statement  Assessment of learning needs 

Equal opportunity form  Declaration of criminal record / DBS 

Declaration of enhanced disclosure status 

SECTION 9

Assessment of Learning Needs

In addition to your supporting statement, you are required to provide an assessment of your learning needs.

As an applicant to a course in higher education, we recognise there may be changes you need to make in your life.

What are the implications of being a student for you, for your personal relationships, for your work?

What are your hopes and fears? What adjustments may you need to make to ensure you can meet the course requirements and maximise your learning opportunities?

Please handwrite(not type) in the space provided. Your assessment should be between 200-350 words.

SECTION 10

Supporting Statement

To do yourself justice you will need to write between 150-250 words under each heading.

You may wish to copy the headings and print

Working with people: What abilities do you bring to your work with people? Do you have any particular qualities that enable your work to be done effectively?

______

Thinking about self: Are there things about yourself as a worker that you want to change? What are the things that please you?

______

Values: In your work with people, are there any values or ideals that are especially important? Why is this so?

______

SECTION 10(Continued)

Supporting Statement

Organising and managing: What are you like as a manager of your own time, of your work? To what extent are you able to handle any demands placed on you by colleagues, friends, and family?

______

The programme: Why are you applying to this programme? Are there any changes you might need to make to undertake the programme?

______

SECTION 11

DECLARATION OF ENHANCED DISCLOSURE STATUS

You are required to complete this form and return it with your application.

Please tick box 1, 2, or 3

 I already have an enhanced disclosure from the employer/s where my professional practice for the College is based. (This must be dated within two years of your programme start date. *) I will provide an original disclosure to the YMCAGeorgeWilliamsCollegefor their records.**

Disclosure Number:______

Date of Issue: ______

Course start date: ______

2.  I do not have an enhanced disclosure dated within two years of the programme start date* and my employer is not in the process of initiating a check. I am willing to apply for a DBS/CRB/Disclosure Scotland PVG Scheme enhanced disclosure through the YMCA George Williams College. I understand there is a charge which I am happy to pay.+ (Not applicable to Channel Islands and Overseas students).

3. I have applied for a DBS/CRB/Disclosure Scotland PVG Scheme/AccessNI/Police Check (CI) (delete as appropriate) enhanced disclosure or police check application via my employer/s where my professional practice for the College is based and the organisation has confirmed in writing for the College my disclosure application form reference number, date of birth and the date when the application form was sent to the bureau.

I give YMCAGeorgeWilliamsCollege permission to contact the organisation that initiated the disclosure/police check, in order to verify that the disclosure/police check took place and that employment was commenced/continued on receipt of the disclosure/police check.

Employer’s Details

Company Name______

Line Manager (print name)______

Full Address & postcode and ______

______

Contact number & Email: ______

Signature______Print Name______Date______

* January/April/September

** Disclosure checks initiated via YMCAGWC will be kept for 6 months only, thereafter destroyed.

+ £62.00 for a DBS/CRB or £65 for a Disclosure Scotland PVG Scheme

SECTION 12

Declaration of a Criminal Record

To help the College reduce the risk of harm or injury to others caused by the criminal behaviour of students, we must know about any relevant criminal convictions that an applicant may have.

Please note that as a professional youth worker, your role is exempt from Rehabilitation of Offenders legislation. This means that you are required to declare all cautions, reprimands or convictions which you have ever received in relation to any illegal activity. If you do not do so, you will normally be required to leave the programme if this is discovered at any future time. Please note that you will not necessarily be barred from the programme because of a criminal record – but you are required to give us full details, in confidence, when you apply.

Have you ever been convicted by the courts or cautioned, reprimanded or given a final warning by the police?

 Yes No

If yes, please give details of offences, penalties and dates.

DateOffencePenalty

______

Are you aware of any future police enquires being undertaken following allegations made against you?

 Yes No

If yes, please give details

______

Print Name ………………………………………...

Signature…………………………………………....

Date......

SECTION 13

Equal Opportunities Monitoring

(Please tick)

Gender

Male 

Female

Ethnic Group

Code Ethnicity

10White

14Irish Traveller 

15Gypsy/ Roma 

21Black or Black British – Caribbean 

22Black or Black British – African 

29 Other Black background 

31 Asian or Asian British – Indian 

32 Asian or Asian British – Pakistani 

33Asian or Asian British – Bangladeshi 

34Chinese 

39 Other Asian background 

41 Mixed – White & Black Caribbean 

42 Mixed – White & Black African 

43Mixed – White & Asian 

49Other mixed background 

80Other ethnic background 

98I refuse to provide this information

Disabilities (please tick the nature of your disability; tick more than one box if necessary):

CodeDisability

00No known disability

02Blind/partially sighted

03Deaf/hearing impediment

04Wheelchair user/mobility difficulties

05Personal Care Support

06Mental health difficulties

07An unseen disability (e.g. diabetes, epilepsy, asthma)

08Multiple disabilities

10Autistic Spectrum 

11A specific learning difficulty (e.g. dyslexia) 

96A disability not listed above 

97I refuse to provide this information

This document will only be used for the purpose of generating statistics for internal and external use and is removed from the application form before an assessment and interview takes place.

SECTION 14: DECLARATION

I hereby certify that the information I have given on this form is correct and complete, and I agree that, if admitted to YMCA George Williams College I will abide by all the Regulations of the College. I have read and understood the instructions relating to the completion of this form, and have noted any details particular to the programme for which I am applying.
I understand that:

I may be asked to provide documentary evidence in support of any statement made on this form.
The information I have given, or will give, in connection with this application, will be processed according to the Data Protection policy of the College.
The College is unable to accept liability for the suspension and/or cancellation of programmes, although it will inform students of changes as soon as possible.
In making this application for admission to the programme named in Section 1, I acknowledge that any offer of admission I may receive is subject to the condition that I fulfil the relevant entrance requirements and that I provide, when asked to do so, original documentary evidence of holding the academic qualifications and of any other information listed above. If, having been admitted, I fail to fulfil that condition, I undertake to withdraw from the College.

Signature of Candidate: ______Date:______
Please send the completed form to: The Registry Administrator, YMCA George Williams College,
199 Freemasons Road, Canning Town, London E16 3PY
You are advised to retain a copy of all documents sent to us for your own records
FOR COLLEGE USE ONLY

Both references  Received on Considered by
Supporting statement  Code Selection day
Assessment of learning needs  Interviewed by Offer place
Certificates 
Enhanced Disclosure: DBS/CRB  ACCESS NI  Channel Islands Police Check Disclosure Scotland 
Equal Opportunity  Declaration of Criminal Record  Declaration of Enhanced Disclosure Status 
Passport  Birth Certificate 
Notes:

SECTION 15: Notes for Referees (1)

Thank you for agreeing to provide us with a reference for the candidate. Your comments are valuable in enabling us to assess their suitability for the programme. As such, we are asking you to submit a thorough description highlighting strengths as well as areas for development, providing examples where possible.

To aid you in this task, we have compiled some guidelines.

About YMCA George Williams College Undergraduate Programmes

The undergraduate programmes offered by YMCA George Williams College are for people with experience of working with others in a youth and/or community setting who wish to develop as reflective professional practitioners. They are endorsed by the Joint Negotiating Committee (JNC) through the National Youth Agency and CLD Standards Council for Scotland and validated by Canterbury Christ Church University.

The College offers two routes to professional qualification. The first is through full-time study based at the College, the second is by distance learning. External candidates who have achieved Dip HE / Foundation Degree level qualifications or professional qualifications in Social Work, Playwork, or teachers with Qualified Teacher Status can enter at level 6 of the BA (Hons). The programme duration is three years full-time and four years by distance learning.

Completing the Reference

Please provide your contact details and indicate if you are/were the candidate’s line manager.

Comment on:

the candidate’s relationship and ability to work with people such as those younger or older, those

from the same and different cultures; those in authority; those for whom the candidate holds some

managerial responsibility

their understanding of ideas, ability to think and reflect
their adaptability to new experiences, reactions to stress
their communication, both verbal and written
their motivation for study
their personal attitudes: ability to recognise own feelings and those of others, reaction to attitudes

and behaviour from others, attitude towards self.

their ability or potential to work with young people aged 13 to 19

In addition, you may comment on any other aspect you feel is relevant.

1st Reference (Line Manager’s Reference)

To the candidate

Please pass these reference sheets and ‘Notes for Referees’ to your referees. Your referee should

complete both sheets. You should then include them in a sealed envelope together with your completed

application pack and send it back to the college.

Full name of candidate: Job title:
Current responsibilities: F/T, P/T, voluntary (please underline)
Number of hours per week:
Full name of referee:
Address:
Postcode
Telephone number: Mobile number:
Website: Email:
Occupation of referee: ______
How long have you known the candidate? From: month/ year ______To: month/year______
In what capacity: (Line manager/ tutor)Please circle Other: state ______
Please comment:
Ability to work with people
Ability to think and reflect
Adaptability to new experiences
Communication
Motivation
Other comments
Signed………………………………….…… Date……………………………………….

Notes for Referees (2)

To aid you in this task, we have compiled some guidelines.

About YMCA George Williams College Undergraduate Programmes

Completing the Reference

Please provide your contact details and indicate if you are/were the candidate’s line manager.

Comment on:

the candidate’s relationship and ability to work with people such as those younger or older, those

from the same and different cultures; those in authority; those for whom the candidate holds some

managerial responsibility

their understanding of ideas, ability to think and reflect
their adaptability to new experiences, reactions to stress
their communication, both verbal and written
their motivation for study
their personal attitudes: ability to recognise own feelings and those of others, reaction to attitudes

and behaviour from others, attitude towards self.

their ability or potential to work with young people aged 13 to 19

In addition, you may comment on any other aspect you feel is relevant.

2nd Reference

To the candidate

Please pass these reference sheets and ‘Notes for Referees’ to your referees. Your referee should

complete both sheets. You should then include them in a sealed envelope together with your completed

applications pack and send it back to the college.

(Complete where applicable)

Full name of candidate: Job title:
Current responsibilities: F/T, P/T voluntary (please underline)
Number of hours per week ______
Full name of referee:
Address:
Post code
Telephone number: Mobile number:
Website: Email:
Occupation of referee: ______
How long have you known the candidate? ______
In what capacity: ( Line manager/ tutor)Please circle Other: state ______
Comments
Ability to work with people
Ability to think and reflect
Adaptability to new experiences
Communication
Motivation
Other comments
Signed………………………………….…… Date……………………………………….