Section 1: Candidate Details (Please print)

Title: Forename: / Surname:
How would you like your name to appear on your certificate?
Address: / Landline:
Address: / Mobile:
Town/City: / Preferred Email address :
County: / Email 2:
Post Code: / Country if not in UK:

2. ATS FE/HE Course Details

Course Title: / Institution/course provider:
Course Leader: / OCR Centre (OCR Courses only):
Education Tutor: / Assessment/Observation Tutor:
Course Start Date: (MM/YY) / Course End Date: (MM/YY)
Level 5 / Level 7

BDA January 2018 Registered Charity No. 289243; Company Ltd. No. 1830587 ATS FE/HE Candidate Form

Candidate Name:

3.Teaching/Professional Qualification:

Teaching Qualification:
Do you hold QTS (Qualified Teacher Status) or QTLS (Qualified Teacher Learning and Skills)? / QTS / QTLS / Neither
Please quote your DfE/QTS/QTLS Number:

4. Teaching/professional educational experience - complete your Teaching Experience, specifying the hours you work(ed) if working part-time. Please note that you must have two years professional educational experience with pupils who are over the age of 18

by the time you apply. This can be two years full time or a combination of part time appointments.

Dates
(From/To)
MM/YY / School, college and location / Subject(s) taught / Age
Range / No. in group / FT/PT / Hours p/w
If P/T
Total Number of hours:These should add up to 2 years, based on 25 hours per week x 38 weeks per year x 2 = 1,900 hours

BDA January 2018 Registered Charity No. 289243; Company Ltd. No. 1830587 ATS FE/HE Candidate Form

Candidate Name:

5. BDA Tutor/Assessor Directory

Professional Members

of the BDA can now upload their details to the online BDA Tutor/Assessor Directory. This is a searchable site for anyone wanting to find professional tutors and assessors.

6. Data Protection

By completing this form, you are agreeing for us to administer your BDA accreditation and where necessary share your information internally within the BDA.

From time to time we may like to send you information about our own products and services that you might be interested in, by post, telephone, email and SMS. We will not pass your information on to any organisation external to the BDA.

If you agree to being contacted in this way, please tick the relevant boxes to indicate how you would like to be contacted:

Email SMSPost Telephone

The BDA is committed to protecting your personal data please see our Privacy Policy on our website at:

7. Candidate’s Signature

Please sign this document by hand. Electronic signatures and fonts will not be accepted.

Signed: / Date:

By signing this application formyou confirm that:

  • A completed Tutor Form is included; applications will not be processed without
  • Payment is included and that fees are not refundable
  • You have the appropriate educational experience before applying
  • You consent for us to hold your personal information as described above
  • All forms are received by the Accreditation Board deadline
  • Accreditation Board decisions are final

Please note that payment is processed on receipt of application but does not imply that accreditation has been awarded
Bank transfers; British Dyslexia Association Sort Code: 20-71-06 Account : 90286141
International: IBAN GB05 BARC 2071 0690 2861 41/SWIFTBIC BARCGB22
Reference: ATS FE/HE your name
Credit/debit cards: Complete the form below and include with your application

Send your completed forms to Accreditation, BDA, 6a Bracknell Beeches, Old Bracknell Lane, Bracknell RG12 7BW

Credit/Debit CardPayment: (ATS FE/HE)

Please debit my account with £70.00

Card Number

X / X / X

Expiry Date

Security Number on reverse of card

Name as printed on the card
Cardholder’s signature / Date

Please note that payment will be taken on receipt of application.

BDA January 2018 Registered Charity No. 289243; Company Ltd. No. 1830587 ATS FE/HE Candidate Form