SKE Application Form

Application for Pre-ITT Subject Knowledge
Mathematics Enhancement Course

Please complete the application carefully and fully using BLOCK CAPITALS in BLACK ink

• The course is a blended learning course which incorporates online distance learning and face to face tuition.
• You will study five modules which cover Higher GCSE onlinefrom 4/6/2016. Access will be through Leeds Trinity’s Virtual Learning Environment (Moodle).
• You will attend two weeks of face to face teaching, Monday to Friday,10am-4pm at Leeds Trinity University, 25/7/16 – 05/8/16
• This will be followed by an individualised learning plan.

SECTION 1

Personal Details

TitleSurname Date of Birth

(Mr/Mrs/Miss etc) Day Month Year

Forename (First Name)Previous Name(s), if changed Gender

M F

Home Address

Postcode: / Home Telephone:
Mobile Telephone:
Email:

Country of Domicile Nationality

Next of Kin

Name: / Relationship (e.g. spouse, parent):
Telephone: / E-mail:

SECTION 2

ITT Provider (this MUST be completed for your application to be considered). The course you are due to commence in September will either be a School Direct, SCITT or Provider Led course. We need the name of the ITT Provider and if it is a SD or SCITT course, we require the name of the Higher Education establishmentit is in collaboration with.

Students are only accepted onto SKE courses if they have already been accepted onto an ITT course leading to QTS.

Name of ITT ProviderUCAS Training code ITT Course Start Date

Lead School (if SCITT or School Direct)Lead School Post Code

SECTION 3

Qualifications to Date

Please give details of all academic qualifications specified in this section.

Do you have a GCSE English Language or equivalent qualification? / Yes / No
Do you have a GCSE Mathematics or equivalent qualification? / Yes / No
Do you have anA ‘level in Maths? If so, what grade?
Grade
/ Yes / No
Do you have a UK Degree or equivalent qualification? / Yes / No
Is your degree a pass award degree or an Honours degree?......
What classification is your degree? (i.e. 2i, 2ii etc)………………………………………….

Please provide details of all qualifications below.Including A’ level or equivalent exams and degree details. Ensure you enter your results.

School/College/University / Start Date / End
Date / Subject/s Taken / Results / Exam Board

SECTION 4

Catering and Accommodation

At Leeds Trinity wecan provide accommodation for SKE students for the two week summer school if required. Accommodation is only available on a first come, first served basis to those living some distance from the University during the two week summer school and there is a charge.

Do you need accommodation at Leeds Trinity? / Yes / No
Do you have any special dietary requirements? / Yes / No

If YES, please provide further details in the space below

Disabilities/Special Requirements

At Leeds Trinity we provide a wide range of additional support to address individual needs. Please let us know if you have a disability such as visual impairment, mental health difficulty, a medical condition such as epilepsy, ME, or if you are hard of hearing, have dyslexia or you are a wheelchair user, for example.

We would be pleased to arrange an informal meeting with you to discuss any individual support requirements.

I have a disability or dyslexia and would like an informal meeting
I have a disability or dyslexia but do not require any additional support

If you have a disability or dyslexia please provide further details in the space below

Further Information

If there is any further information that we need to know about your application for, or attendance on, the SKE course, please provide this in the space below.

SECTION 5

Declaration

DATE PROTECTION ACT 1998: The information that you have supplied will be processed and held on computer. The data may be processed for the purpose of compiling statistics, and passed to the Higher Educational Statistical Agency. By signing and returning this application form you will be deemed to be giving your consent to the processing of said data.

I consent to the processing of the data contained in my computer record. I hereby grant LeedsTrinityUniversityCollegeauthority to release information relating to my academic status to my funding body or other agencies appropriate.

Date of completion

Signature

Day Month Year

Please email your completed application form to:

or

Post the form to:

Catherine Bell

Institute of Childhood and Education

Leeds Trinity University

Brownberrie Lane

Horsforth

Leeds

LS18 5HD

Once your application form has been processed, we will contact you with details of how to register on the course.

Further information about the Leeds Trinity SKE Courses can be found on our website at:

Admission Decision (OFFICE USE ONLY)

Accept Signature of Admissions TutorDate


Reject
Date Application form received:
Date form taken to admissions:
Date the form was ATR’d (made live) :
Date a log on id was produced: