CIPFA Certificate in Financial Reporting for Academies Application Form

Please scan and email your completed form to:
If you do not have access to a scanner please post your form to CIPFA, 221 Borough High Street, London, SE1 1JA
Please ensure all parts are completed in full prior to submission.

1. Personal Details

Title First Name Other Initials Surname

Home Address

Postcode / Date of Birth / Sex M*/F*
__ __/__ __/______
Home Telephone Number
Home Email Address
Personal Mobile Number

2. Employment Details (if applicable)

Name of Employing Organisation

Work Address
Post Code
Job Title
Department
Work Telephone Number
Work Email Address
Work Mobile Number (if different to personal mobile)

3.Reasons for Application

Do you presently work within an Academy?
If no, is your school looking to convert to an Academy in the near future (please state anticipated date)?
What school phase do you work within?
What is your current job title?
Are you a member of your school’s Senior Leadership Team?
What are your main reasons for wanting to complete the CIPFA Accredited Certificate in Financial Reporting for Academies programme?
How will completion of this training benefit your school/organisation?

4. Previous Qualifications

What is your highest level of qualification?
What is the title of this qualification?
What year did you obtain this qualification?
Have you completed or are you completing the Certificate in School Business Management (CSBM)?
If so, in which year did you complete the CSBM?
Have you completed or are you completing the Diploma in School Business Management (DSBM)?
If so, in which year did you complete the DSBM?
Have you completed or are you completing the Advanced Diploma in School Business Management (ADSBM)?
If so, in which year did you complete the ADSBM?

5. Course Fees Please give details of who should be invoiced. This information is required in full by our Accounts Dept.

EMPLOYER SPONSORED STUDENTS ONLY

Addressee for Invoicing (Invoices will be emailed so a valid email address must be provided)
Name:
Job Title:
Organisation:
Dept:
Address:
Tel No.
Email:
Responsibility for Payment (to be signed by hand by the sponsor only. Printed/electronic signatures will not be accepted)
I hereby accept responsibility for payment of the appropriate course fees, in accordance with CIPFA’s terms and conditions of application and acceptance*.
Signed
Print Name
PO No. / Date

SELF FUNDED STUDENTS ONLY

Responsibility for Payment - To be completed by all self funding student regardless of payment method
I, the self funding student, herewith state that I have read and agree with CIPFA terms and conditions of application and acceptance* and undertake to be responsible for all course fees.
Signed
Print name

If selecting this option you will be contacted by a member of the CIPFA team to confirm your credit/debit card details once formal approval of your application and eligibility for the programme has been confirmed.

  1. Declaration – Data Protection

 The information I have given on this form is correct.

 I agree to the processing of personal data contained in this form, or other data which CIPFA may obtain from me or other people, whilst I am a participant on this programme.

 I agree to the processing of such data for any purposes connected with my studies or for any other legitimate reason.

Please tell us how you heard about the CIPFA Accredited Certificate in Financial Reporting for Academies programme?

Applicants Signature:______

Date:______

* CIPFA’s terms and conditions of application and acceptance are available to download from the CIPFA website

Please note that some information on this form will be held on computer and used for statistical purposes. 1 of 3