CYQ Professional Development Application Form
112 Great Russell Street, London WC1B 3NQ
Published On: 20/09/2012 /

If completing this application form by hand please use BLOCK CAPITALS

* Represents mandatory fields

Surname: * / Home telephone: *
First names: * / Work telephone: *
Address: * / Mobile phone:
Postcode:* / Email address:*
Date of birth:* / Male / Female: *
What is your occupation?
How did you hear about CYQ Professional Development?
What is the name of the CYQ approved centre you work for (if applicable)? *

Please see the Professional Development section of the CYQ website for course/unit titles, start dates and venues

Course/Unit / Startdate / Venue

** Unit 2: Assess Occupational Competence in the Work Environment

The evidence must be generated in a real work environment - in the course of carrying out your assessment activities.

You must show evidence of carrying out at least two assessments of two learners’ occupational competence (four assessments in total)

** Unit 3: Assess Vocational Skills, Knowledge and Understanding

You must show evidence of carrying out at least two assessments of two learners from a simulated environment (four assessments in total)

** Unit 5: Internally Assure the Quality of Assessment

You must have access to at least two assessors in order to gather assessment evidence

Please specify any training relevant to the minimum requirements for the training you are booking.
Examining body / Level / Subject / Grade / Date awarded

This information is treated confidentially and it will only be used to help you

Do you haveany of the following needs? (Please tick)

A learning difficulty Dyslexia Visual or hearing impairment English as a second language

A need not listed here Please give details:

Are you a wheelchair user? Yes No

If you have answered yes to any question, or think that your progress on the course will be affected,please call
020 7343 1800 or email for information and guidance.

The following information is required in order for us to monitor the diversity of applicants.

Ethnic origin – how would you describe your ethnic origin? (Please tick)

White
01 British
02 Irish
03 Any other White background
Please state: / Mixed
04 White and Black Caribbean
05 White and Black African
06 White and Asian
07 Any other mixed background
Please state: / Asian or Asian British
08 Indian
09 Pakistani
10 Bangladeshi
11 Any other Asian background
Please state:
Black or Black British
12 Caribbean
13 African
14 Any other Black/African background
Please state: / Chinese or other ethnic group
15 Chinese
16 Any other background
Please state: / Other
00 Not disclosed
DR01 None
DR02 Vegan
DR03 Vegetarian / DR04 Gluten free
DR05 Other
Please state:
Please read and confirm you understand and accept the following. Please accept via the checkboxes below.

I am in a position where I can perform assessment/quality assurance activities

I understand that I need to have access to two candidates to complete Unit(s) 2 and/or 3 of the Assessorcourse

I understand that I need to have access to two assessors to complete Unit 5 of the Internal Quality Assurercourse

I acknowledge that I need to complete this qualification within 18 months of course attendance

I understand that video evidence of practical delivery is required and I am able to provide this. Where this is not possible I agree to pay the additional fee for an assessor to observe me directly

I have received appropriate information and / or visited the CYQ website prior to booking

I have read understood and agreed to theTerms and Conditions(overleaf) and confirm that the details provided are, to the best of my knowledge, correct

I am happy to receive further information from CYQ Professional Development

Signed*: / Date*:
Please indicate payment method. (Please tick)

Credit/Debit Card (please contact the CYQ Customer Support Team on 020 7343 1800)

Purchase Order (please specify this number below, if applicable)

Cash (in person only,do not send cash through the post)

Cheque (please complete the section below, if applicable)

Postal Order (please complete the section below, if applicable)

Purchase Order Number:

Cheque or Postal Order payments:

I enclose the sum of £______which includes any applicable deposit which is non-refundable.

awarding excellence

Central YMCA Qualifications part ofCentralYoungMen’sChristianAssociation.RegisteredcharityNo.213121.LimitedcompanyregisteredinEngland119249.

Registeredoffice:112GreatRussellStreet,LondonWC1B3NQ.YMCA®isatrademarkregisteredinGreatBritainandNorthernIreland.ISO9001accredited.

Office Use Only

CRMED RGELIGA

Terms and Conditions

Forwarding payment in any means to Central YMCA Qualifications Professional Development demonstrates your understanding and acceptance of the terms and conditions as detailed below.

This is an agreement between Central YMCA Qualifications Professional Development (to be known as CYQPD for the purpose of this document) and you. These terms and conditions apply to your application for a programme of study and subsequent matters arising from that application. They aim to outline your obligation as a learner and our obligation to you. All bookings are subject to availability.

For the purposes of this document “course” refers to any CYQPD programme of study including related assessment(s). All bookings and alterations to bookings are made subject to availability.

Additional support for learners with individual needs

CYQPD will offer support to learners with individual learning needs and/or disabilities. It is the learner’s responsibility to inform CYQPD of any individual needs on the application form so that appropriate support can be provided.

Balance payments

Balance payments are due at least four weeks before the programme start date. If the balance payment is not received by this time, all fees paid will be forfeited and the course place will be cancelled.

Cancellation & Transfer Policy

CYQPD will advise learners of any intention to cancel a course at least three weeks before the intended course start date where permitted. If a course is cancelled within this timeframe a free transfer or refund will be offered.

No refunds will be given for any transfer or cancellation requests made within four weeks of the course or assessment start date, unless a medical certificate for the learner has been provided. There is however, a seven day cooling off period for telephone bookings, during which you can cancel or transfer free of charge.

Fees may be transferred free of charge from one course to another if more than four weeks’ notice is given. Refunds for cancellations made with four weeks’ notice will be subject to either the deposit amount or 25% of the course fee if there is no deposit.

Certificates

Certificates are issued in the name stated on the application form. Replacement certificates can be provided for an additional fee. Please contact CYQPD for further details. Certificates will not be issued unless the course fee has been paid in full.

Changes to personal details

It is the learner’s responsibility to ensure that CYQPD is provided with the correct personal information. Changes to name require a copy of legal documentation. CYQPD will not be liable for any errors due to incorrect personal information.

Confirmation of choice

Signing an application form and/or the terms and conditions section on the application form confirms that the learner is attending the course of his or her own choice and that, even if an employer or other party is paying the fees, the learner accepts the value of the course and its benefits.

Data Protection

CYQPD will comply with the Data Protection Act in respect of any information supplied by you to us and ensure that your data is fairly and lawfully processed and only used for the purposes for which it was given.

Fees which have not been set against a particular course

Monies that are transferred for any reason into a holding account will be held up to one year only. After this time any unused fees will be lost.

Health & Safety

All learners must comply with the legislation relevant to the working areas and behave in a manner that does not put his/herself or others at risk. All learners must familiarise themselves with Fire Evacuation Procedures. Corridors and stairways, which are provided for the safe passage of people using the venues, should not be obstructed.

Invoice bookings

For courses paid by companies rather than individuals, we require a completed application form and purchase order which includes (in block capitals) the full name, address and telephone number of the authorising signatory, accepting our terms and conditions.

Legal status

CYQPD is the business name of Central YMCA Qualifications (for the delivery of assessing and quality assurance qualifications). This is a company registered in England and Wales number 119249 and is a registered charity number 213121. The registered office is 112 Great Russell Street, London WC1B 3NQ.

Postal and fax bookings

CYQPD will not take any responsibility for delayed postal and fax applications. Course bookings will always be processed on a first come, first served basis, and will only be accepted when accompanied by a completed, dated, and signed application form and appropriate payment. A deposit (where applicable) must accompany applications submitted more than four weeks prior to the course start date to guarantee a place. Deposits are non refundable. Purchase order payments must be accompanied by a completed, dated, and signed ‘purchase order cover sheet’ and a fully completed, dated and signed application form. Full payment is required at time of booking when made within four weeks of the course start date or where no deposit is applicable.

Refunds

Any refunds will be made to the individual or company that made the initial payment(s). If payments have been made by more than one individual/company then, where these have been separately identified at the time of payment, the net refund will be made to the individual/company concerned divided in the same proportions to the original payments.

Re-sits/individual assessments

Re-sit assessments are not included in the course price so there will be additional fees if you refer. Assessments and re-sits cannot be cancelled or transferred within four weeks’ notice of the assessment start date. Requests for cancellations or transfers before this time will be subject to an administration charge amounting to 25% of the assessment fee.

Telephone bookings

Telephone bookings must be accompanied by telephone payment. There is a seven working day cooling off period for telephone bookings, the day of booking being the first day. During this time, a cancellation or transfer can be made free of charge. This does not apply once the course has started.

Unacceptable behaviour

Aggressive and/or threatening behaviour and any other conduct likely to cause offence or harm to others will not be tolerated on CYQPD courses including without limitation: offensive and or racist language and behaviour; acting in an unsafe manner; harassment of others; damage or defacement or property; disruption to the work or recreation of others; bringing alcohol or drugs to the learning environment. Any learners guilty of such behaviour will be removed from the course and all fees paid will be forfeited. If any learner’s behaviour results in breaches of the law, CYQPD reserves the right to involve the police and to prosecute the individual(s) concerned.

Venues

The use of the course venue and its amenities is not included, other than for the purposes of the course being attended (unless otherwise stated). If learners wish to use the facilities at a venue they must check with the venue staff prior to use and follow staff instructions.

awarding excellence

Central YMCA Qualifications part ofCentralYoungMen’sChristianAssociation.RegisteredcharityNo.213121.LimitedcompanyregisteredinEngland119249.

Registeredoffice:112GreatRussellStreet,LondonWC1B3NQ.YMCA®isatrademarkregisteredinGreatBritainandNorthernIreland.ISO9001accredited.