Application for UKCC Level 4 Post Graduate Diploma Programme (Talent Development)

Please fully complete ALL sections of the Application Form providing as much information as possible. Incomplete information may result in a delay in the processing of applications.

Section 1: Personal Details
Title: / Age: / Date of birth:
First name: / PLEASE SEND A PASSPORT SIZED PHOTOGRAPH WITH YOUR APPLICATION:
Surname:
Address: / Postcode:
Home tel. no.: / Mobile tel. no.:
E-mail address: / Gender: / SelectMaleFemale
Skype address (if available):
Country of permanent residence:
Country of birth:
Nationality:
If born outside the UK, date of first entry to live in UK:
Section 2: Details of fee paying arrangements
Please select payment option by clicking hereOption 1: I will be paying my own tuition feesOption2: I will be sponsored by my employer or NGBOption 3: I am in receipt of a grant/scholarshipOption 4: An other orgnisation is sponsoring me
If you selected option 2-4 please give a contact name/address of your employer / NGB, sponsor, other organisation:
Name:
Address:
Section 3: Please give details of physical or other disability or medical condition which might necessitate special arrangements or facilities
Disability/Special Needs (please refer to Notes for Guidance)
Section 4: Educational Background (Institutions attended) / From (month & year) / To
(month & year) / FT, PT or SW
Section 5: Most recent qualifications (including HND, First Degree, appropriate overseas qualifications and all relevant professional qualifications)
Type of qualification / Awarding Body / Month / Year / Subject / Grade
Section 6: School/College qualifications (including GCE A/AS levels; BTEC OND/ONC; Adv GNVQ)
Type of qualification / Awarding Body / Month / Year / Subject / Grade
Section 7: Employment (Please indicate your employment experience including any details relevant to the course for which you are applying)
Present employer (if any)
Name:
Address:
Nature of work:
Dates: / From to
E-mail address:
Tel no.:
Previous employers
Name of employer / Role / Nature of work / Dates
From to
From to
From to
From to
From to
From to
From to
Section 8: Further Information
Please state here your reasons for wishing to pursue the course. Give details of any other relevant skills, such as Information Technology and Research Methods. Indicate any other achievements or experience that will support your application. You may wish to discuss this section with the course leader/ NGB contact.
Please indicate if you are able to attend the interview date for selection on <insert date> / Please selectYesNo
Please indicate if you are able to attend the proposed induction dates for the course on the 14th and 15th August 2011. / Please selectI am able to attend both datesI am unable to attend either datesI am able to attend the 14/08/2011 onlyI am unable to attend the 14/08/2011I am able to attend 15/08/2011 onlyI am unable to attend the 15/08/2011 only
Section 9: Criminal Conviction
If you have a criminal conviction please tick this box □
□ I do not want to be contacted by the University with details of its courses or of its other products and services.
Declaration: I confirm that the information given on this form is true, complete and accurate and no information requested or other significant information has been omitted.
Print Name:
Date:
Section 10: Reference/NGB supporting statement
(1) Statement by Referee
Name of referee:
Name of applicant:
Post/occupation/relationship to applicant:
Address:
Tel. no: (including STD)
Fax no.: (including STD)
How long have you known the applicant and in what capacity?
Can this reference be discussed with the applicant? / Please selectYesNo
Can this reference be revealed to the applicant? / Please selectYesNo
In order to select those coaches who will benefit from their chosen programme of study the University requires a supporting statement from a referee or the NGB recommending the coach to the programme. The reference about the coach should, if possible, cover the following:

Suitability for the course
Intellectual qualities including previous academic performance
Personal characteristics including evidence of the ability to sustain study
Career aspirations

Print Name:
Date:
(2) Statement by Referee
Name of referee:
Name of applicant:
Post/occupation/relationship to applicant:
Address:
Tel. no: (including STD)
Fax no.: (including STD)
How long have you known the applicant and in what capacity?
Can this reference be discussed with the applicant? / Please selectYesNo
Can this reference be revealed to the applicant? / Please selectYesNo
In order to select those coaches who will benefit from their chosen programme of study the University requires a supporting statement from a referee or the NGB recommending the coach to the programme. The reference about the coach should, if possible, cover the following:

Suitability for the course
Intellectual qualities including previous academic performance
Personal characteristics including evidence of the ability to sustain study
Career aspirations

Print Name:
Date:
Section 11: Monitoring Data
A person is regarded disabled if they have a physical, sensory or mental impairment which has a substantial and long term effect on their ability to carry out normal day-to-day activities.
In your view, are you disabled in terms of the above definition? / Please selectYesNo
If ‘Yes’, do you consider that your disability might make if difficult for you to participate in any part of the course? / Please selectYesNo
Please indicate the nature of your disability: / Please SelectHearingPhysicalLearningMobilityMultipleVisualPrefer not to sayOther
If you have answered yes to any of the above questions, please give brief details and indicate any special requirements you may have and/or what we can do to ensure that you are given every opportunity to demonstrate your abilities.
Ethnic Origin (this information will not be made available to Admissions Tutors for selection purposes) Please choose from the ethnic origin terms printed here the one which you feel most nearly describes your ethnic origin
Asian British – Bangladeshi / Black African / White British
Asian British – Indian / Black British / White European
Asian British – Pakistani / Black Caribbean / White Irish
Bangladeshi / Dual Heritage (White and Black African) / White Non-European
Indian / Dual Heritage (White and Black Caribbean) / Other White
Pakistani / Any Other Dual Heritage - please specify / Chinese
Dual Heritage (white and asian) / Prefer not to say
Where did you hear about us? / Please selectWeb pagesInternetPress advertisingRadio advertisingProspectusWord of mouthCurrent student on the courseOther

As appropriate, we reserve the right to check your applications for entry to the UK with the relevant British Government office.

All the personal information provided above, together with any further information the University obtains is used to process your application. It may also be used by the University to undertake research to plan or improve our services. In addition the University may advise you of other study opportunities and services provided by it. If you do not wish to receive this information please write to Advancement, Foster Building, UCLAN

On completion of your application form, please email it to:

Please remember to complete all sections of the form and attach a passport sized photograph with your application form.

Version 3 March 2011