Centre for Academic Practice
ATP Admissions, Centre for Academic Practice, Rutland Building, Loughborough University, Leicestershire LE11 3TU
Application for Admission to the Associate Teaching Pathway
Please complete all sections in type, providing as much information as possible.
Title.(delete those not applicable) / Forenames / Surname or family name
Mr, Mrs, Ms, Miss, Dr. Prof.
University of Loughborough Department/School
Your contact details.(We will use these to notify you of the success of your application. Please inform us immediately of any changes.)
Tel.no.: / Email:
Details of current role
Role title and Job family / Contract type / If relevant contract start date and contract end date
Type of teaching you will be undertaking during the structure pathway programme (e.g. supervision, one-to-one, seminars, lectures, one-off sessions, tutorials, labs, workshops etc)
Details of when you will be teaching and/or supporting learning during the ATP(This Programme is practice-based, and it is important for the Programme Team to be aware if there are specific issues related to your teaching practice, for example if you are only teaching toward the start or end of the semesters or only in certain weeks)
Highest and most recent academic qualification
Qualification / Subject / University or institution / Date Awarded
If you are currently enrolled upon any Professional Development Courses/Academic Programmes please indicate details here:
Course/Programme / Subject / Deliverer / Expected completion date
If English is not your first language, please indicate any English Language qualifications
Name of qualification / University or institution / Date Awarded / Grade/Mark obtained
Special Needs (Please outline any special needs support that you may require as a consequence of any disability or medical condition in order to fully undertake your ATP studies.)
Fees:
Loughborough University undertakes to meet the tuition fees for any staff accepted onto, and engaging with this programme. This is part of the institution’s commitment to developing teaching and learning, through supporting the development of individual members of staff.
Please indicatewhy you wish to take this course. (What are your expectations and aims? If you have specific requirements in terms of teaching and learning development please indicate them here.) Take as much space as you need.
Supporting Reference from your Line Manager (In completing this section Line Managers indicate their support for engagement with the programme in terms of recognition of workload as part of the applicant’s Continuing Professional Development)
In signing this form I confirm I have discussed with the applicant and agreed the terms for their engagement with the course.
Name
Title
I confirm that I am the Line Manager for (insert name) and that I support their application to undertake the Associate Teaching Pathway
Signed: Date:
Declaration: I confirm the above information is correct to the best of my knowledge.
Typed signature permissible.
Signed:
Date:
Please indicate if youhave any of the following:
Dyslexia (01)Blind / are partially sighted (02)
Deaf / have a hearing impairment (03)
Wheelchair user / have mobility difficulties (04)
Personal care support (05)
Mental health difficulties (06)
Unseen disability e.g. diabetes, epilepsy, asthma (07)
Multiple disabilities (08)
A disability not listed above (09)
No known disabilities (00)
Please return your completed form to:
CAP@lboro putting ATP Application in the subject line
For Departmental use only
University Decision
Date of Entry
Participant informed
Details of requested special requirements support
Date support put in place
Associate Teaching Pathway Application Form 2018 onwards