Specialist Dyslexia Training for Teachers (ATS/AMBDA) 2015-2016 Registration Form

Notes for Guidance – PLEASE READ BEFORE COMPLETING THE FORM

Please complete ALL sections of this form. Failure to do so may result in us not being able to register you on the programme. If you require assistance with completing the form, please contact us at inclusion@edgehill.ac.uk

Section 1, Personal Details Please provide us with two email addresses if possible as all correspondence will be via email.

Section 2, Award and Module Details Module PBM4033, Identification, Assessment and Intervention for Students with Dyslexia, leads to recommendation for Approved Teacher Status only for those who have QTS and 2 yrs teaching experience Module PBM4033, Identification, Assessment and Intervention for Students with Dyslexia, leads to recommendation for Approved Practitioner Status only for Teaching Assistants and HTLA educated who do not have QTS.

The PGCert SpLD leads to recommendation for Associate Membership of the BDA.

Please indicate which programme you wish to study. NB – you will be given an opportunity to change your mind at a later date.

For both ATS and AMBDA, once you have gained your qualification you will need to apply to the BDA for the status/membership. BDA do make a charge for this.

Section 3, Employment To qualify for AMBDA the BDA specify you must have at least 2 years teaching experience

Section 4, Study Background Your Teacher Reference Number (TRN) was formerly known as your DfE number.

Section 5, Equal Opportunities Monitoring Data This information is optional. Please tick “Decline Information” if you do not wish to provide it.

Submission of Registration Form A hard copy of the registration form is required with the applicant’s signature. It may be submitted via email but please note that the form must be a scanned copy showing the original handwritten signature. Please email to: inclusion@edgehill.ac.uk Alternatively, you can post your completed form to: Inclusion Projects, Faculty of Education, Edge Hill University, St Helens Road, Ormskirk, Lancashire, L39 4QP

School Declaration This must be signed by your Head teacher or Chair of Governors and returned along with your submitted registration form. Please ensure if sent via email it is a scanned copy showing the original handwritten signature.

For office use only

If you have studied at Edge Hill before, please state your Student ID Number:

1 Personal Details

Surname: Title (Mr, Mrs, Miss, Ms, etc):

First Names: Previous Surname

(if applicable):

Gender: Date of Birth: Nationality:

Home Address:

Postcode: Country of Permanent Residence:

Email Address 1: AEmail Address 2:

Home telephone: Mobile:

2. Award and Module Details

Please indicate which programme of study you wish to follow:

Module PBM4033 Identification, Assessment and Intervention for Students with Dyslexia (ATS only)

Module PBM4033 Identification, Assessment and Intervention for Students with Dyslexia (APS only)

PGCert SpLD Specialist Dyslexia Training for Teachers Programme (including ATS and AMBDA)

3 Employment

School name: School Local Authority:

School address:

School postcode: Headteacher email:

School telephone: Name of Headteacher:

Your current role: Number of years you have been a teacher:

Age Range taught

4 Study Background

Do you hold QTS or QTLS?

YES NO Teacher Reference Number:

Have you previously studied a higher education course (i.e., above A Level) in the UK for at least 6 months?

YES NO

Do any of your parents (whether natural, adoptive, step-parents or guardians) have any higher qualifications, such as a Degree, Diploma of Higher Education, etc?

YES NO

Registration Form for

Professional Development

2015/2016 Specialist Dyslexia Training for Teachers (ATS/AMBDA)

Received: SID:

Acknowledged: SS:

Please enter the full name and town/city of the last education establishment you attended:

Please state your highest current qualification:

5 Equal Opportunities Monitoring Data (Optional)

Edge Hill University uses this information to monitor our equal opportunities and widening participation policies. This information is used solely for statistical purposes. If you prefer not to provide this information, please tick ‘Decline information’.

Do you have a disability?

YES NO Decline information

Are you in receipt of Student Disability Allowance?

YES NO Decline information

What is the nature of your disability?

Please choose from the terms printed below the one which you feel most nearly describes your ethnic origin:

□ 10. White

Black or British

□ 21. Caribbean

□ 22. African

□ 29. Other

Asian or Asian British

□ 31. Indian

□ 32. Pakistani

□ 33. Bangladeshi

□ 34. Chinese

□ 39. Other Asian background

Mixed

□ 41. White/Black Caribbean

□ 42. White/Black African

□ 43. White Asian □ 49. Other Mixed background

□ 80. Other Ethnic background

□ Decline information

6 Fees (Please note fees will be invoiced per module)

££ Total cost of the programme is £2450. For cost per Module please contact a member of the Inclusion Projects Team.

Fees are to be paid 3 weeks after the commencement of each module.

Please indicate who will be responsible for payment of your fees:

Self School Other (e.g. half by self, half by school)

If other, please provide details:

____________________________________________________________________________________________________________

7 Declaration

To be completed by the teacher:

I confirm that I have read and understand the Student Data Collection Notice (Appendix 1). I confirm that the information given on this form is correct. By signing this form I agree to abide by the policies and procedures of Edge Hill University and understand that the institution may take action against individuals who contravene them.

Overseas Students: Edge Hill University reserves the right to inform the UK immigration authorities if the student ceases to attend classes. Overseas students must inform the International Office of any changes relating to attendance/registration at the University.

Signature: Date:

If you are unable to attach an electronic signature please print out the completed form and sign it. This form should be completed

in full and returned to Inclusion Projects, Edge Hill University, Faculty of Education, St Helens Road, Ormskirk, Lancashire, L39

4QP or inclusion@edgehill.ac.uk

For assistance with completion of this form, please contact 01695 650 997/01695 657285

IN ORDER TO ASSIST WITH OUR MARKETING PLEASE STATE WHERE YOU HEARD ABOUT THIS PROGRAMME:

Specialist Dyslexia Training for Teachers (ATS/AMBDA) - School Declaration To be completed by the Head Teacher on behalf of the school

PART 1 – TO BE COMPLETED BY ALL SCHOOLS

Name of teacher:

Name of school:

Address of school:

Name of Head Teacher

Please provide a brief statement confirming the above named participant’s suitability to undertake the programme.

Does the above named participant has satisfactory DBS clearance from your school?

Yes No

Please confirm the above named participant will be released / supported to attend the programme.

Yes No

PART 2 – TO BE COMPLETED BY SCHOOLS FUNDING OR PART-FUNDING THE ABOVE TEACHER

The total cost of this programme is £2450. I understand that Edge Hill University will invoice my school (name and address as above) per module and that invoices will be distributed shortly after the commencement of each Module.

Please specify what proportion of fees the school will be responsible for:

NB: If a teacher withdraws from the programme more than 3 weeks after the commencement date the full payment is still payable.

Please list any specific details you would like to be included on the invoice:

Name of School:

Signature: Date:

If you are unable to attach an electronic signature please print out the completed form and sign it.This form should be completed in full and returned to Inclusion Projects, Edge Hill University, Faculty of Education, St Helens Road, Ormskirk, Lancashire, L39 4QP or inclusion@edgehill.ac.uk

£

Appendix 1

Data Protection Act 1998 – Student Data Collection Notice 2013-14

Introduction and scope:

Under the Data Protection Act (1998) Edge Hill University are the Data Controllers of the information that students provide. The University ensures that all data is managed in line with the ‘Eight Data Principles’ of the Data Protection Act (1998) and processes the information provided for education and training administration, ancillary and support services as well as for statistical analysis.

The University has notification under the Act to collect relevant personal information about its students including data about admissions, background, academic programme, progress and graduation together with information about accommodation and Equal Opportunities monitoring. Information is collected via the student enrolment form and data supplied to the University through the relevant admissions processes. The information collected is to maintain student records and to support the administration of the University, it will be shared with Faculties and Departments only as required to support the operational needs of the Institution. The data collected relates to all students registered with the University, including those registered as University students but taught at another Institution as part of a collaborative arrangement or an exchange programme.

Information:

Information will be disclosed to 'The Higher Education Funding Council for England’ (HEFCE) and its agencies such as Higher Education Statistics Agency (HESA) as part of statistical returns and primarily for statistical analysis. This use may result in the publication and release of data to other approved users, which may include academic researchers and commercial bodies.

Records made up of mainly coded information, or parts of it, will be passed to Government Agencies as part of a statistical return to carry out their statutory functions in relation to the funding of education, which include:

Department for Education (DfE) Department for Innovation and Skills (DIUS) National Assembly for Wales (NAW) Scottish Executive (SE) Department for Employment and Learning, Northern Ireland (DEL(NI)) Higher Education Funding Council for England (HEFCE) Higher Education Funding Council for Wales (HEFCW) Scottish Higher Education Funding Council (SHEFC) Teacher Training Agency (TTA) Department of Health (DH) Research Councils (RCs)

Audit Issues

The University or Government or their respective agents will check the accuracy of personal information provided by students against external data sources. For example, the University will test whether a student has been reported on earlier HESA or individualised learning record (ILR) returns of other Institutions and contact those other Institutions for confirmation of any qualifications obtained. Your record will not be used by HESA or any of the above bodies in a way that can identify you or affect you individually. Your contact details will not be made available to HESA.

Funding and Sponsors

Your information on registration and progression will be passed to the Student Loan Company/Student Finance Direct/NHS Business Services Authority for funding purposes and if appropriate to assess eligibility for EHU Bursaries and Scholarships. Sufficient information will be disclosed to the University External Debt Collector to allow the pursuit and recovery of monies. If you are sponsored, attendance and results will be passed to your sponsor.

National Student Survey

HEFCE carry out a statutory National Student Survey and they or a nominated agency may contact you to participate and this information will be used only for that purpose. When you qualify, further data about you will be collected and information on how this will be used will be provided at that time.

Plagiarism Software

When you submit your assessed work it may be submitted to the Turnitin Plagiarism Detection software database.

SMS Text Messaging including Emergency Situations

The University may contact you by text message via an external provider. Situations where the University may contact you include cancellations/changes to the teaching timetable/placements and in emergency situations.

Student Union

In order to assist the Student Union in managing its membership and to provide appropriate services the University will transfer student data to the Student Union who will manage this information in accordance with

Data Protection and Information Security Legislation. To opt out of membership you should write to the Academic Registrar and the President of the Student Union.

Sensitive Personal Data

If your programme involves you working with children or vulnerable adults, in discharge of its statutory responsibilities, the University may transfer your personal information to the Criminal Records Bureau or other relevant external bodies to enable routine vetting to take place. Sharing of information will be kept to a minimum and where this includes sensitive personal data, the University will ask for your consent.

Disabled Students

If during admission, enrolment or by informing the University you provide information concerning a disability which you believe you have, please be aware that unless you notify us otherwise, you will be giving your explicit consent to this information being shared with appropriate University employees to ensure that suitable arrangements can be made for you. Sharing of personal data in such circumstances will be kept to a minimum.

Exchange Students

If your education involves an exchange programme with another Institution, your course is run in collaboration with another Institution or organisation or involves work experience or similar, it may be necessary for the University to share personal data with another Institution in order to allow you to study or to undertake work experience. Sharing of personal data in such circumstances will be kept to a minimum. If this includes sensitive personal data you will be asked for your consent.

Placement Students

If your education involves a placement element it will be necessary for the University to share personal data with relevant placement providers in order to allow arrangements to be made for your placement. Sharing of data in such circumstances will be kept to a minimum. If this includes sensitive personal data you will be asked for your consent.

Enrolment Form

You are being asked to read the Declaration carefully before you complete and sign your University Enrolment Form. By signing the form you are agreeing to your details being entered into and stored securely on the University Student Records Database, confirming that you will be liable for any tuition fees (unless the SLC are paying them on your behalf) and agreeing to abide by all University policies, procedures and Regulations. You are also agreeing to share your name, programme and contact details with the agencies outlined above, you understand the purpose that the information you are providing will be used for and to the best of your knowledge it is correct. A digital photograph of you will be taken, stored on your student record and printed on your UNICARD for ID purposes, on class lists and used for identification purposes normally as part of a disciplinary investigation. In addition it may be issued to the Police. You do not have to complete the Equal Opportunities box however, if you do you are agreeing to the University returning the data to HESA as part of a statutory statistical return.

University Publications

Students who wish their names to be excluded from University publications e.g. on Graduation or Alumni lists should put this in writing to the Academic Registrar in Academic Registry.

Disclosure of Information

The University may disclose information regarding your status as a student to the Department for Work and Pensions (regarding applications for benefit or as part of a criminal investigation), the Police/Courts, the UKBA and the Local Council for Electoral Registration purposes. Disclose to organisations not listed will be made only where there is legitimate reason.

Help and Advice:

If you have any queries regarding your personal data held by the University please write to the Strategic Planning and Policy Unit, there is a small fee made for providing this information. If you have concerns or objections regarding the use or publication of your data please write to the Academic Registrar, Edge Hill University, St Helens Road, Ormskirk, Lancashire, L39 4QP, United Kingdom. You also have the right to see a copy of the data held by HESA or if you have any concerns or objections to the use of data please contact: HESA at www.hesa.ac.uk, or by writing to 95 Promenade, Cheltenham, GL50 1HZ.