Application FormSection 1: Select Programme

BA Hons Children, Young People and Families Option 1 – Youth Work, Community Learning & development, and Social Pedagogy Option 2 - Relational Practice

MA Youth Work and Community Learning & Development

MA Reflective Leadership and Management

Short Courses Professional Studies in Supervision Leadership, Coaching and Mentoring Strategic Leadership and Management

Section 2: Personal Details

Title and surname

First names (underline the name you are usually known by)

Date of birth

Previous surname (if applicable)

Nationality:

Do you require a Visa to study in the UK?

National Insurance No.

Permanent address:

Postcode

Length of residence. years/months_____

Previous address:

Postcode

Length of residence.

years/months_____ __________

Home telephone No: Work telephone No:

Work fax number:

Please state how you heard about our courses

Newspaper

Journal

College website

Search engine

Word of mouth

Other

Mobile number:

E-mail:

Work website:

Work email:

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

from to

Job title Name and address of organisation

Reason for leaving

Date

from to

Name of School/ College/University

Subjects/Course Level Date of results

Grade

Section 5: Relevant Training

Datefrom

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 x

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: Second contact Name:Relationship to Student Relationship to student:Address:

Landline Telephone No.Mobile Telephone No.

Section 8: Application Checklist

1st reference (line manager) 2nd reference Supporting statement Additional support section Assessment of learning needs Equal opportunity form Health section 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?

Your assessment should be between 200-350 words.

Section 10: Supporting Statement

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?

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 12: Declaration of 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 x 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: Equal Opportunities Monitoring

GenderMale Female

Ethnic Group

Code Ethnicity10 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 -

Considered by

Supporting statement

Code

Received on

Selection day

Assessment of learning needs

Interviewed by

Offer place Yes/No/Conditional

Certificates

Enhanced Disclosure: DBS 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

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 BA Hons Children, Young People and Families course is aimed at people who are interested in working with children, young people, and families. Students are able to choose from two options.

1. Option one is for those students who wish to gain a professional qualification in youth and community work.

2. Option two provides an opportunity for those who are interested in developing a broader focus as relational practitioners in the Children, Young People and Families sector. Option 2 does not confer professional qualification.

The MA Youth Work and Community Learning & Development course is for graduates who want to qualify as professional youth and community workers.

The MA Reflective Leadership and Management course is for people who have worked in the field of youth and community work, and/or related fields, and are now looking to progress their skills as leaders and managers, whilst maintaining a focus on reflective practice.

All short courses listed form part of the MA courses but are offered as discreet short courses as well. Students who successfully complete a short course are eligible for advanced standing against the relevant MA programme.

Completing the Reference

Please provide your contact details and indicate if you are/were the candidate’s line manager.

Comment on:

1. 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

2. their understanding of ideas, ability to think and reflect3. their adaptability to new experiences, reactions to stress4. their communication, both verbal and written5. their motivation for study6. their personal attitudes: ability to recognise own feelings and those of others,

reaction to attitudes and behaviour from others, attitude towards self.7. their ability or potential to work with young people aged 13 to 19

8. In addition, you may comment on any other aspect you feel is relevant.

1st Reference (Line Manager)

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 completedapplication pack and send it back to the college.

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: Mobile number:

Email:

Occupation of referee:

How long have you known the candidate?

In what capacity:

Other: state

Ability to work with people

Ability to think and reflect

Adaptability to new experiences

Communication

Motivation

Other comments

Signed

Date:

2nd Reference

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 completedapplication pack and send it back to the college.

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: Mobile number:

Email:Occupation of referee:

How long have you known the candidate?

In what capacity: ( Line manager/ tutor) Please circle

Other: state

Ability to work with people

Ability to think and reflect

Adaptability to new experiences

Communication

Motivation

Other comments

Signed

Date