Please complete all sections
For support in completing this form please phone 01924 434600 or
1. CENTRE INFORMATION
1.1 / Date of Application:
1.2 / Centre Name:
1.3 / Sites where course will be delivered:
1.4 / Person submitting this application / Name:
Role:
Email:
1.5 / Does the Centre currently have Direct Claims Status (DCS)? / Yes / No / Please note that DCS will not be awarded for new provision until it has operated successfully for a year.
1.6 / Please state any material changes to the organisation since the original application. / eg; organisation structure, merger with another organisation, new partnership arrangements for the delivery of the course,bankruptcy arrangements.
2.Course Details(NB Course details enable Certa to set up the new provision on the Certa IT system)
2.1 / Course Title:
2.2 / Proposed start date:
2.3 / Intended Credit Value:
2.4 / Learners will be:
(Please identify all that apply) / 14-19 years / 19-25 years / Over 25 years
2.5 / How will your learners be funded?
(Please identify all that apply) / EFA / Other
2. Course Details (cont’d)
2.6 / Number of learners anticipated each year:
2.7 UNITS THE CENTRE WANTS TO DELIVER
Unit Title / Unit Level / Credit Value / QCF RITS Code
4. PEOPLE WHO WILL DELIVER THE NEW PROVISION
Please list below the names and qualifications of the people who will be delivering, assessing, and internally verifying the unitsand the sites that they will be supporting. Please include occupational qualifications where the Qualification Specification requires them.
Person’s name and the Qualification Title and Level for which they are responsible / Responsibility
T=Tutor
A = Assessor
IV = Internal Verifier / Qualification(s) held
including teaching qualifications and occupational or vocational qualifications listed as a requirement in the Qualification Specification
e.g. PGCE, CTLLS, DTLLS, D32, A1, D34, V1, TAQA. / If delivery is to be at more than one site please indicate where each person will be working.
If a person carries out different roles at each site please show the roles in brackets at each separate site.
See example below.
Example:-
Fred Boggs
Certificates in Business Admin L2 & L3 / T, A, IV / DTLLS, D32, D34 / Goole (IV)
Barnsley (T, A, IV)
Please note that Certa will require copies of CVs for all Tutors, Assessors and Internal Verifiers who are listed above, if they were not listed on the original Centre Recognition Application Form. We will also need to examine the original certificates for all their listed qualifications at the next Certa Centre Monitoring visit.
5. QUALITY ASSURANCE
Please ensure that the following policy documents are up to date:
- Access to Fair Assessment (Reasonable Adjustment and Special Considerations) Policy
- Appeals Procedure for Learners
- Complaints Procedure
- Contingency Plan that will safeguard the interests of the learners and ensure that they receive continuity in their programme of learning, should any problems arise.Disability Discrimination Policy
- Equal Opportunities and Diversity Policy
- Health and Safety Policy
- Internal Verification Policy
- Policy and procedures for the prevention and investigation of malpractice, maladministration and plagiarism. The procedure must include the prevention and notification of Adverse Effects e.g. loss, theft of, or a breach of confidentiality in, any assessment or examination material.
- Policy on authenticating learner work and/or identification
- Policy on checking for criminal records
6. DECLARATION
I declare that:
□I am authorised by the Centre named in 1.2 to supply the information provided in this application
□the information is, to the best of my knowledge and belief, true and complete
□the policies listed in Section 5 are up to date
□the Centre agrees to comply with the Certa Centre Agreement.
I agree to inform Certa immediately should any changes occur to the information supplied in this application.
Signature: / Name:
Position: / Date:
For Certa office use only
Element / Check / Signature / Comments
Finance check
QA: Delivery (Sections 2 and/or 3)
QA: Centre Risk Band
QA: Staff qualified to deliver Qualification or Units
Other (please state)
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