Undergraduate Programmes Application Form SECTION 1: Select programme (leave blank if you are uncertain which programme to apply for) Please refer to guidelines for completing an application Full-Time Honours Degree (3 years) Preferred location for Sept 2015 year 1 students: Medway, Kent East London No preference BA(Hons) Youth Work and Community Learning and Development BA(Hons) Education and Learning (Youth Work and Community Learning and Development) BA (Hons) Social Pedagogy (Youth Work and Community Learning and Development) Distance Learning Honours Degree (4 years) Level 3 Diploma (Rank Foundation YAP students only) BA(Hons) Youth Work and Community Learning and Development BA(Hons) Education and Learning (Youth Work and Community Learning and Development) BA (Hons) Social Pedagogy (Youth Work and Community Learning and Development) SECTION 2: Title and surname PERSONAL DETAILS First names (underline the name you are usually known by) Date of birth Previous surname (if applicable) Nationality: National Insurance No. Permanent address: Do you require a Visa to study in the UK? YES/NO Previous address: Postcode Postcode Length of residence. years/months Length of residence. years/months Home telephone No: Work telephone No: Please state how you heard about our courses Mobile number: E-mail: Who will pay your tuition fees? Work fax number: Work website: Work email: Newspaper Journal College website Search engine Word of mouth Other Self-funding Employer Please state Local Authority Please state Student Loan Company Other Please give details Rank Foundation (YAP)
SECTION 3: EMPLOYMENT DETAILS Complete this section if you are currently employed in youth work or a related field. Name and full address of organisation including postcode: Line manager Your job title When started (month/ year) Full-time/part-time/voluntary (please underline) Number of hours worked per week Current responsibilities: Please provide details of any relevant work history (paid or voluntary) Dates Job title Name and address of organisation Reason for leaving from to Other relevant experience Please continue this section on a separate page if necessary
SECTION 4: EDUCATION: SECONDARY/FURTHER/HIGHER Date from to Name of School/ College/University Subjects/Course Level Date of results Grade Originals of relevant certificates will be required at interview SECTION 5: RELEVANT TRAINING from Date to Course title Course provider Length & /or number of sessions Qualification/result
SECTION 6: ADDITIONAL LEARNING SUPPORT Do you have any additional learning support needs? No Yes If yes, please explain below Are you dyslexic? No Yes Are you applying for Disabled Student Allowance? Yes No SECTION 7: HEALTH DETAILS and Emergency Contact Details Do you consider yourself to have a disability? Yes No Are you registered disabled? Yes No (if yes, please provide details) Are you at present receiving treatment for any unseen disabilities? Yes No (e.g. asthma, diabetes, epilepsy) If so, please provide details Do you have any health issues that may affect your ability to undertake this programme? Yes No (If so, please provide details) Please provide details of who you would like us to contact in the event of an emergency: First Contact Name: Relationship to Student: Address: Landline Telephone No.: Mobile Telephone No.: Email: Second contact Name: Relationship to student: Address: Landline Telephone no.: Mobile Telephone no.: Email: SECTION 8: HOW DO I COMPLETE AN APPLICATION? Please note that this application will not be considered unless all of the following have been completed: 1 st reference (line manager) Additional support section 2 nd reference Health section Supporting statement Assessment of learning needs Equal opportunity form Declaration of criminal record / DBS Declaration of enhanced disclosure status
SECTION 9 Assessment of Learning Needs In addition to your supporting statement, you are required to provide an assessment of your learning needs. As an applicant to a course in higher education, we recognise there may be changes you need to make in your life. What are the implications of being a student for you, for your personal relationships, for your work? What are your hopes and fears? What adjustments may you need to make to ensure you can meet the course requirements and maximise your learning opportunities? Please handwrite (not type) in the space provided. Your assessment should be between 200-350 words.
SECTION 10 Supporting Statement To do yourself justice you will need to write between 150-250 words under each heading. You may wish to copy the headings and print Working with people: What abilities do you bring to your work with people? Do you have any particular qualities that enable your work to be done effectively? Thinking about self: Are there things about yourself as a worker that you want to change? What are the things that please you? Values: In your work with people, are there any values or ideals that are especially important? Why is this so?
SECTION 10 (Continued) Supporting Statement Organising and managing: What are you like as a manager of your own time, of your work? To what extent are you able to handle any demands placed on you by colleagues, friends, and family? The programme: Why are you applying to this programme? Are there any changes you might need to make to undertake the programme?
SECTION 11 DECLARATION OF ENHANCED DISCLOSURE STATUS You are required to complete this form and return it with your application. Please tick box 1, 2, or 3 1. I already have an enhanced disclosure from the employer/s where my professional practice for the College is based. (This must be dated within two years of your programme start date. *) I will provide an original disclosure to the YMCA George Williams College for their records.** Disclosure Number: Date of Issue: Course start date: Or 2. I do not have an enhanced disclosure dated within two years of the programme start date* and my employer is not in the process of initiating a check. I am willing to apply for a DBS/CRB/Disclosure Scotland PVG Scheme enhanced disclosure through the YMCA George Williams College. I understand there is a charge which I am happy to pay.+ (Not applicable to Channel Islands and Overseas students). Or 3. I have applied for a DBS/CRB/Disclosure Scotland PVG Scheme/AccessNI/Police Check (CI) (delete as appropriate) enhanced disclosure or police check application via my employer/s where my professional practice for the College is based and the organisation has confirmed in writing for the College my disclosure application form reference number, date of birth and the date when the application form was sent to the bureau. I give YMCA George Williams College permission to contact the organisation that initiated the disclosure/police check, in order to verify that the disclosure/police check took place and that employment was commenced /continued on receipt of the disclosure/police check. Employer s Details Company Name Line Manager (print name) Full Address & postcode and Contact number & Email: Signature Print Name Date * January/April/September ** Disclosure checks initiated via YMCAGWC will be kept for 6 months only, thereafter destroyed. + 62.00 for a DBS/CRB or 65 for a Disclosure Scotland PVG Scheme For Registry: DBS/CRB/DiscScot/AccessNI/Police Check Disclosure Seen: YES/NO Children/Vulnerable Adults/Both checks Registered Body: Cleared: YES/NO GWC authorised clearance: Date Letter received from employer YES/NO Application form reference number Date sent to DBSCRB
SECTION 12 Declaration of a Criminal Record To help the College reduce the risk of harm or injury to others caused by the criminal behaviour of students, we must know about any relevant criminal convictions that an applicant may have. Please note that as a professional youth worker, your role is exempt from Rehabilitation of Offenders legislation. This means that you are required to declare all cautions, reprimands or convictions which you have ever received in relation to any illegal activity. If you do not do so, you will normally be required to leave the programme if this is discovered at any future time. Please note that you will not necessarily be barred from the programme because of a criminal record but you are required to give us full details, in confidence, when you apply. Have you ever been convicted by the courts or cautioned, reprimanded or given a final warning by the police? Yes No If yes, please give details of offences, penalties and dates. Date Offence Penalty Are you aware of any future police enquires being undertaken following allegations made against you? Yes No If yes, please give details Print Name... Signature... Date...
SECTION 13 Gender Male Female Equal Opportunities Monitoring (Please tick) Ethnic Group Code Ethnicity 10 White 14 Irish Traveller 15 Gypsy/ Roma 21 Black or Black British Caribbean 22 Black or Black British African 29 Other Black background 31 Asian or Asian British Indian 32 Asian or Asian British Pakistani 33 Asian or Asian British Bangladeshi 34 Chinese 39 Other Asian background 41 Mixed White & Black Caribbean 42 Mixed White & Black African 43 Mixed White & Asian 49 Other mixed background 80 Other ethnic background 98 I refuse to provide this information Disabilities (please tick the nature of your disability; tick more than one box if necessary): Code Disability 00 No known disability 02 Blind/partially sighted 03 Deaf/hearing impediment 04 Wheelchair user/mobility difficulties 05 Personal Care Support 06 Mental health difficulties 07 An unseen disability (e.g. diabetes, epilepsy, asthma) 08 Multiple disabilities 10 Autistic Spectrum 11 A specific learning difficulty (e.g. dyslexia) 96 A disability not listed above 97 I refuse to provide this information This document will only be used for the purpose of generating statistics for internal and external use and is removed from the application form before an assessment and interview takes place.
SECTION 14: DECLARATION I hereby certify that the information I have given on this form is correct and complete, and I agree that, if admitted to YMCA George Williams College I will abide by all the Regulations of the College. I have read and understood the instructions relating to the completion of this form, and have noted any details particular to the programme for which I am applying. I understand that: I may be asked to provide documentary evidence in support of any statement made on this form. The information I have given, or will give, in connection with this application, will be processed according to the Data Protection policy of the College. The College is unable to accept liability for the suspension and/or cancellation of programmes, although it will inform students of changes as soon as possible. In making this application for admission to the programme named in Section 1, I acknowledge that any offer of admission I may receive is subject to the condition that I fulfil the relevant entrance requirements and that I provide, when asked to do so, original documentary evidence of holding the academic qualifications and of any other information listed above. If, having been admitted, I fail to fulfil that condition, I undertake to withdraw from the College. Signature of Candidate: Date: Please send the completed form to: The Registry Administrator, YMCA George Williams College, 199 Freemasons Road, Canning Town, London E16 3PY You are advised to retain a copy of all documents sent to us for your own records FOR COLLEGE USE ONLY Both references Received on Considered by Supporting statement Code Selection day Assessment of learning needs Interviewed by Offer place Certificates Enhanced Disclosure: DBS/CRB ACCESS NI Channel Islands Police Check Disclosure Scotland Equal Opportunity Declaration of Criminal Record Declaration of Enhanced Disclosure Status Passport Birth Certificate Notes:
SECTION 15: Notes for Referees (1) Thank you for agreeing to provide us with a reference for the candidate. Your comments are valuable in enabling us to assess their suitability for the programme. As such, we are asking you to submit a thorough description highlighting strengths as well as areas for development, providing examples where possible. To aid you in this task, we have compiled some guidelines. About YMCA George Williams College Undergraduate Programmes The undergraduate programmes offered by YMCA George Williams College are for people with experience of working with others in a youth and/or community setting who wish to develop as reflective professional practitioners. They are endorsed by the Joint Negotiating Committee (JNC) through the National Youth Agency and CLD Standards Council for Scotland and validated by Canterbury Christ Church University. The College offers two routes to professional qualification. The first is through full-time study based at the College, the second is by distance learning. External candidates who have achieved Dip HE / Foundation Degree level qualifications or professional qualifications in Social Work, Playwork, or teachers with Qualified Teacher Status can enter at level 6 of the BA (Hons). The programme duration is three years fulltime and four years by distance learning. Completing the Reference Please provide your contact details and indicate if you are/were the candidate s line manager. Comment on: the candidate s relationship and ability to work with people such as those younger or older, those from the same and different cultures; those in authority; those for whom the candidate holds some managerial responsibility their understanding of ideas, ability to think and reflect their adaptability to new experiences, reactions to stress their communication, both verbal and written their motivation for study their personal attitudes: ability to recognise own feelings and those of others, reaction to attitudes and behaviour from others, attitude towards self. their ability or potential to work with young people aged 13 to 19 In addition, you may comment on any other aspect you feel is relevant.
1 st Reference (Line Manager s Reference) To the candidate Please pass these reference sheets and Notes for Referees to your referees. Your referee should complete both sheets. You should then include them in a sealed envelope together with your completed application pack and send it back to the college. Full name of candidate: Current responsibilities: Job title: F/T, P/T, voluntary (please underline) Number of hours per week: Full name of referee: Address: Postcode Telephone number: Website: Mobile number: Email: Occupation of referee: How long have you known the candidate? From: month/ year To: month/year In what capacity: (Line manager/ tutor) Please circle Other: state Please comment: Ability to work with people Ability to think and reflect
Adaptability to new experiences Communication Motivation Other comments Signed. Date.
Notes for Referees (2) Thank you for agreeing to provide us with a reference for the candidate. Your comments are valuable in enabling us to assess their suitability for the programme. As such, we are asking you to submit a thorough description highlighting strengths as well as areas for development, providing examples where possible. To aid you in this task, we have compiled some guidelines. About YMCA George Williams College Undergraduate Programmes The undergraduate programmes offered by YMCA George Williams College are for people with experience of working with others in a youth and/or community setting who wish to develop as reflective professional practitioners. They are endorsed by the Joint Negotiating Committee (JNC) through the National Youth Agency and CLD Standards Council for Scotland and validated by Canterbury Christ Church University. The College offers two routes to professional qualification. The first is through full-time study based at the College, the second is by distance learning. External candidates who have achieved Dip HE / Foundation Degree level qualifications or professional qualifications in Social Work, Playwork, or teachers with Qualified Teacher Status can enter at level 6 of the BA (Hons). The programme duration is three years fulltime and four years by distance learning. Completing the Reference Please provide your contact details and indicate if you are/were the candidate s line manager. Comment on: the candidate s relationship and ability to work with people such as those younger or older, those from the same and different cultures; those in authority; those for whom the candidate holds some managerial responsibility their understanding of ideas, ability to think and reflect their adaptability to new experiences, reactions to stress their communication, both verbal and written their motivation for study their personal attitudes: ability to recognise own feelings and those of others, reaction to attitudes and behaviour from others, attitude towards self. their ability or potential to work with young people aged 13 to 19 In addition, you may comment on any other aspect you feel is relevant.
2 nd Reference To the candidate Please pass these reference sheets and Notes for Referees to your referees. Your referee should complete both sheets. You should then include them in a sealed envelope together with your completed applications pack and send it back to the college. (Complete where applicable) Full name of candidate: Job title: Current responsibilities: F/T, P/T voluntary (please underline) Number of hours per week Full name of referee: Address: Post code Telephone number: Website: Mobile number: Email: Occupation of referee: How long have you known the candidate? In what capacity: ( Line manager/ tutor) Please circle Other: state Comments Ability to work with people Ability to think and reflect
Adaptability to new experiences Communication Motivation Other comments Signed. Date.