Teaching and Learning Exchange

PGCert Academic Practice - Application Form – 2017/18

STUDENT ID: / OR I do not have a UAL student ID
1. Your Personal Details
Surname Title
*please use your full legal name as on your passport* (Mr/Mrs/Ms/Dr/Prof)
Forename(s)
Familiar Name (if different)
Date of birth (dd/mm/yy) Female Male / 2. Your current role:
Lecturer/ Senior Lecturer
Programme/Course Leader
Associate Lecturer
(240 + hours teaching pa)
Associate Lecturer
(less than 240 hours pa. Please specify no. hours:
)
Technician
Librarian
Other – please specify:
3. Contact Details
Telephone Mobile Email:
Permanent Address
Flat Number/House Name
Street Name
Town/City
Postcode
Country / Correspondence Address [if different]
From this date Until this date
Flat Number/House Name
Street Name
Town/City
Postcode Country
Nationality (as on official documentation, e.g. passport) / Date of Entry into the UK [if applicable]
(excluding vacations)
Country of residence during the last three years
(Please attach a copy of your passport)
Emergency Contact
Please provide the name of someone you would like to be contacted in the event of an emergency:
Name
Phone Number/s

4. Educational Qualifications
Please provide details of the highest qualification you hold:
Institution name / Qualification / Grade / Date of Award
Please attach relevant documentary evidence (e.g. Copy of degree certificate.)
5. English Language Proficiency
Is English your first language? Yes No
If you have not completed your secondary or higher education in the medium of the English language, you will need to provide evidence of your English language ability before you start the course. The English language requirement for entry is IELTS 7.0 with a minimum of 6.0 in any one paper, or equivalent.
English Language Qualifications
Please provide details of any qualifications that you hold or you are currently studying.
Qualification / Grade / Date completed/to be completed
Please attach relevant documentary evidence (eg. Copy of your language certificate)
6. Teaching/Supervision Experience
To qualify for a place on the PGCert you need to be teaching a minimum of 35 hours a year at Level 4
or above within the Framework for Higher Education Qualifications (FHEQ) in England, Wales
and Northern Ireland.
Please give details of your current teaching practice:
Institution(s) where you teach / Title of course(s) taught / Title of learning support role
Is your current teaching position: / Hours per academic year / What percentage of your teaching is:
Full time Part time
Other please specify: / FE % (Foundation)
HE % (BA/FdA)
PG % (PG Cert/PG Dip/MPhil/PhD)
Please attach an original reference written on headed paper from your Line Manager. The reference should confirm/comment on the quality/type of teaching you undertake, and on the number of hours you teach a year.
7. 2017/18 Unit Choices
·  You can find more information about each unit of study on our website:
(http://www.arts.ac.uk/about-ual/teaching-and-learning/professional-development/)
·  Please remember to check you meet the entry requirements
·  It is your responsibility to check you can attend on the dates shown, and to make a note of the session dates in your diary.
1st Mandatory Unit (Please indicate 1st, 2nd and 3rd choice in the boxes below)
Choice (1,2 and 3) / Home/EU Fee / International Fee
Teaching and Learning – Group A (Mondays) / £945 / £1,920
Teaching and Learning – Group B (Wednesdays) / £945 / £1,920
Teaching and Learning – Group C (Fridays) / £945 / £1,920
Optional Units (Please Choose One)
Running January –May 2018 / Home/EU Fee / International Fee
Learning for Sustainability / £945 / £1,990
Inclusive Learning and Teaching in Higher Education / £945 / £1,990
Curriculum Design and Implementation / £945 / £1,990
Technology Enhanced Learning / £945 / £1,990
Academic Leadership / £945 / £1,990
Supervising Research Degrees (applicants need to be supervising PhD students) / £945 / £1,990
Introduction to Practice as Research / £945 / £1,990
2nd Mandatory Unit (Please indicate 1st, 2nd and 3rd choice in the boxes below) You will be enrolled onto this unit once you have completed Introduction to Teaching and Learning and one optional unit.
Choice (1,2 and 3) / Home/EU Fee / International Fee
Self-initiated Project - Group A (Mondays, starting January 2019) / £945 / £1,990
Self-initiated Project - Group B (Wednesdays, starting September 2018) / £945 / £1,990
Self-initiated Project - Group C (Fridays, starting September 2018) / £945 / £1,990
8. Fees
Total Fee amount:
£ / Who will pay your fees?
Sponsor/ Employer Self-funded
(50% of the total fee is due 2 weeks before teaching begins, with the remainder paid in 2 instalments)
Name of Sponsor:
Signature of External Payer (Employer/Self)
Signed ......
Date
Name/position : / Address for invoicing
9. Terms and Conditions
Minimum Attendance
All of the workshops are compulsory unless stated on the timetable. Much of the work is collaborative and absences from face-to-face or online activities will impact on others. If you miss a session you may find yourself at a significant disadvantage and the additional support we can give you in this case will be limited.
Withdrawals
You may withdraw from an Academic Practice unit up to half-way through without penalty i.e. the mid-point between the first face to face activity and the final hand-in deadline. Please contact the Admin Team if you require the precise date. To withdraw from a unit participants need to complete and return the withdrawal form, which is available on Moodle, or we can email it to you. Failure to withdraw from a unit on or before the deadline will result in academic penalties i.e. a failure of the unit during the Exam Board, which may impact on future grades.
Unit fees will not be refunded unless the withdrawal form is received on or before the deadline. Withdrawal from mandatory units may result in withdrawal from the entire course. All withdrawals and non-attendance will be reported to interested parties i.e. sponsors, staff development departments and line managers.
Cancellations
University of the Arts London reserve the right to cancel or postpone units. In the event of cancellations participants will be offered alternatives.
Capacity
Courses and units are subject to availability. UAL reserve the right to close courses/units to further applications once maximum capacity has been reached, and before application deadlines.
Academic Regulations
Participants on Academic Practice courses and units are subject to University of the Arts London Academic Regulations as outlined on the UAL website:
http://www.arts.ac.uk/study-at-ual/academic-regulations/
Privacy Notice
By completing this form you are agreeing for us to share your personal information with University of the Arts London departments and individuals such as Staff Development, your Line Manager, Human Resources and Registry.
In addition, we may need to share your information with external professional bodies such as the Higher Education Academy (HEA), the Staff and Educational Development Association (SEDA) and the Higher Educational Funding Council for England (HEFCE.)
Further details on how your information is used, how we maintain the security of your information and your rights to access the information can be obtained from our website:
http://www.arts.ac.uk/study-at-ual/academic-regulations/student-regulations/privacy-policy/
10. Signature of applicant:
I have read and understand the terms and conditions as outlined above.
I agree to use my UAL student email address upon enrolment for all unit correspondence.
I have provided an active email address on the application form (for pre-enrolment correspondence only)
I have enclosed an original reference from my Line Manager on headed paper
I have enclosed copies of my qualifications
Copies of my passport and academic qualifications are attached
Proof of my English Language proficiency is attached (if applicable)
I expect to be teaching a minimum of 35 hours a year at Level 4 or above within the Framework for
Higher Education Qualifications (FHEQ) in England, Wales and Northern Ireland.
Signed ...... Date
Name (please type/print):
11. NEXT STEPS: Please return this form to:
AP Applications
Teaching and Learning Exchange
University of the Arts London
6th floor 272 High Holborn
London WC1V 7EY