Soccer Awareness School of Development

Application Form

PERSONAL DETAILS

Gender *

Male

Female

Forename(s) *

Surname *

Previous Surname

D.O.B *

dd/mm/yyyy

Age *

on 31st August 2019

Address *

Postcode *

Telephone *

Mobile *

Email Address *

Parent/Guardian's Names and Surnames *

Parent/Guardian Mobile Number *

Parent/Guardian Email Address *

National Insurance Number *

(this will be required at point of enrolment at the latest)

*APPLICANTS NOT BORN IN THE UNITED KINGDOM PLEASE COMPLETE THIS SECTION*

Country of birth

Your nationality

Have you lived in the UK or other European Union/EEA country for the last 3 years?

YES

Emergency contact Name

Telephone Number

MOST RECENT SCHOOL/COLLEGE EDUCATION

Name of School/College *

Give Details of all exams taken or pending Subject

MATHS *

Level e.g GCSE

ENGLISH *

Level e.g GCSE

Others

Level e.g GCSE

Results - Predicted

MATHS *

ENGLISH *

Others

Actual

MATHS *

ENGLISH *

Others

EMPLOYMENT

Please enter previous and present employment in date order (you may include details of voluntary work).

Employer's name and address

Nature of work

From (date) To (date)

WHAT DO YOU PLAN TO DO AFTER COMPLETING THIS COURSE?

ADDITIONAL SUPPORT QUESTIONNAIRE

Other - please give details

2. Do you have a disability? *

Yes

If you answered 'YES' to question 2 please give details:

3. Do you have a learning difference? (e.g. Dyslecia, Dyspraxia etc) *

YES

If you answered 'YES' to question 3 please give details:

4. Do you have a social worker or support worker? *

YES

5. Do you have any mental health issues? *

YES

If you answered 'YES' to question 5 please give details:

6. Is English your second language? *

YES

If you answered 'YES' to question 6 please give details:

7. Is there any other support you would require whilst on this course? *

YES

If you answered 'YES' to question 7 please give details:

8. Do you have an Educational Health Care Plan? *

YES

If you require additional space for any questions, please use this box.

Please declare whether you have relevant* convictions or current proceedings against you. *

YES

*If you answer yes we will contact you and ask for more details. We are only interested in proceedings or criminal convictions that relate to violence, are of a sexual nature or involve unlawfully supplying controlled drugs or substances. If you fail to declare information it may result in disciplinary action being taken against you once you have enrolled on the course.

DECLARATION

I confirm that to the best of my knowledge the information given on this form is correct. *

PLEASE STATE YOUR FULL NAME

Today's Date *

dd/mm/yyyy

GDPR Compliance Notice

All personal information that SASODC holds is processed in accordance with current UK data protection legislation. The information you provide on this application form will be used for providing the services outlined in this document. Your data may be shared with other public bodies for purposes of funding and regulatory compliance. We will contact you where necessary in order to provide the service detailed in this application form. For more information about how we use your data, please see our full privacy notice at sasodc.co.uk/privacy-policy