PORTH AGORED and UNIVERSITY OF WALES, TRINITY ST DAVID
APPLICATION to UNDERTAKE
GRADUATE CERTIFICATE IN CONSOLIDATION OF SOCIAL WORK PRACTICE
1ABOUT YOU
Please complete this form in block capitals and give to your Line Manager for signature before returning it to ......
Name: ...... ………….Tel. No: ………………………………………
Local Authority: ...... Employer ID or Pay No: ......
Date of Social Work Qualification :……………………………… University:…………………………
Care Council Registration No………………......
I am, Full Time Part Time Part time, my weekly hours are
Service area: ...... Team: ………………………….. E-Mail….………………………
Workplace address:……….……………………………………………………………………………..
I am a UK citizen (tick box) OR insert nationality here......
List here all the posts you have held since qualifying. Identify in particular, posts in which you undertook the Social Worker role(continue on separate sheet if necessary):
FromToPost/Service area
FromToPost/Service area
Tell us here, if you have any special requirements we need to take account of e.g. dyslexia
……………………………………………………………………………………………………………
In what language are you likely to prepare and submit your portfolio?
English onlyWelsh onlyCombination of English and Welsh
2ABOUT THE PROGRAMME
Name: Graduate Certificate in Consolidation of Social Work Practice - 60 credits Level 6
University: University of Wales, Trinity St David
Programme start date: ……………………………………Expected duration: 12 months
3YOUR AGREEMENT AND SIGNATURE
I agree to:
- undertake the consolidation programme diligently and apply myself appropriately in order to develop my skills and knowledge
- meet with my mentor and line manager (if different) to agree support arrangements, my learning needs as part of the programme, including attendance at all appropriate training courses that may be available as a part of my Local Authority training course calendar and opportunities for observation and assessment
- discuss and complete a learning agreement with my mentor/line manager and take personal responsibility for keeping it under review and progressing any actions agreed as part of it
- allow my employer and PorthAgored (or any of their commissioned providers), the University of Wales, Trinity St David and Care Council for Wales, to share with each other, any and all information that comprises my application form or any other data I provide, including information about my progress on the programme, my results or comments about my portfolio. Such data may be stored, shared, analysed and reported for administration, monitoring, review and quality assurance of the Graduate Certificate programme or ongoing professional registration purposes.
Employee signature:...... …………………Date:…………………………………….
4YOUR LINE MANAGER’S AGREEMENT AND SIGNATURE
I have discussed this application with the applicant and confirm:
the applicant has successfully completed a period of probation, has been confirmed in post, has satisfactorily completed their first year in practice, and is now ready to begin the consolidation of social work practice programme
I will provide or arrange to provide sufficient assessment opportunities in order for him/her to evidence competency and undertake required observations or provide appropriate expert witness testimony for use within the candidate portfolio. Where opportunities may not be immediately available within the team, I will arrange to provide these elsewhere within the Service, or draw any difficulties to the attention of the Training Manager.
I am social work qualified prepared to act as the applicant’s mentor; OR
I am not social work qualified or unable to act as the applicant’s mentor but have arranged for this role to be undertaken by(please PRINT)………………………………….whose contact details are ..…….………………………………………………......
…………………………………………………………………………………………..
Tel:………………………………E Mail:.………………………………………………
I agree to release the applicant for any mandatory training component of the programme and any training courses that I/the mentor agree as being appropriate to meeting agreed learning needs
I agree to familiarise myself with the programme requirements and attend the mandatory induction workshop for managers/mentors.
Any other comments…………………………………………………………………………………………………
……………………………………………………………………………………………………………
Signed ……………………………Print name:……..…………………….. Date ………………………
Name of Mentor if different for above......
Please send the completed application form to ......
Training Mgr/Officer signature ……………………………Name:……..…………………Date….. …
Porth Agored Application Form V1.2 05/08/13- 1 -