Application torun additional activity

GCSEPhysicalEducation(5PE02/5PE04)MLN1

PleaseuseaseparateMLN1formforeachactivity.TheMLN1,andwherenecessaryMLN2form,mustbereturnedtothePEAssessmentTeam–rPEAssessmentTeam,Pearson,One90HighHolborn,London,WC1V7BH,by30thOctoberintheacademicyearthisactivitywillbefirsttaught.ApplicationsthatmissthisdeadlinewillnotbeprocessedforteachinguntilAprilinthefollowingyear.

Pleasenotethatasignatureisrequiredtoprocessyourapplication,failuretoincludeasuitable signaturemayresultintheapplicationbeingreturnedanddelayprocessingforyourcentre.SeeMLNGuidancedocumentforacceptablesignaturetypes.

SectionA
Centre information / Refnumber:
Pearsonuseonly
Centrename: / Centrenumber:
Activity name: / Academicyearinwhichtheactivitywill befirst
assessed:
Is this a pre-approved MLNactivity:
Yes No 
(seelistonPE subject page under‘meeting localneeds’– tickthe appropriate) / Activitygroup:
(see pages38-38 inthespecification,ticktheappropriate)
Name ofcontact atcentre: / Telephone:
Emailaddress:
SectionB
Activityinformation–wherenecessaryprovidewrittenjustification
1.Availabletowholecohort
() Yes No  / No.ofcandidateswho willbetaught this activity:
2. Whichrole(s)willbeofferedinthisactivity?(For Leaders/officialspleaseusethegenericcriteria inthespecification.Donotcomplete aMLN2form) / Player/participant() 
Leader
Official
3.Isthisatimetabledactivity? / () Yes No 
4.Istheactivitydeliveredduringcurricular/extra-curricular
time? / () Yes No 
5.Howlongiseachlesson?
6.Iftaught/assessedatanexternalvenuewhere?
7.Iftaught/assessedatanexternalvenuehowwill
candidategettothevenue?
8.Isthecentrerunning/co-ordinatingtheactivity / () Yes No 
9.Whoisresponsibleforteaching/assessingthe
candidates?
10. Isthereadequateaccesstoand provisionofequipment
tolearntherelevantskillsandbeassessed / () Yes No 
SectionC
Statementbyteacher/assessor
I understandtheMeeting Local Needsprocessand thatif any of the above informationisfound tobe inaccuratePearsonreservestheright to
withdrawpermissiontoassessthisactivity.WhereassessmentcriteriahavebeenprovidedbythecentreitisappropriateforassessmentatGCSElevel.TheHeadteacher/Principalisawareofthisapplicationtorunanadditionalactivity.
StatementbyHeadteacher/Principal
I understandtheMeeting Local Needsprocessand thatif any oftheabove information is foundtobe inaccuratePearsonreservestheright to
withdrawpermissionforthisactivity.IconfirmthatIsupportthisapplicationtoassessthisactivityatthecentre.