Application for Early Years Teacher Status
Please complete the application carefully using BLOCK CAPITALS in BLACK ink/type.
SECTION 1
1.1 Programme of Study:
Title of Programme Proposed Date of Entry
EYTSMonth Year
1.2 Personal Details
Title Surname Date of Birth
(Mr/Mrs/Miss etc) Day Month Year
Forename (First Name) Previous Name(s), if changed
Home Address
Postcode: / Home Telephone:Mobile Telephone:
Email:
Next of Kin
Name: / Relationship (e.g. spouse, parent):Telephone: / E-mail:
SECTION 2
Employment details
2.1 Confirmation of Current Employer and School/Setting’s agreement to train EYTS candidate
(to be completed by your current school/setting employer’)
Address:Postcode: / Name of School/Setting Contact with Responsibility for EYTS Candidate/s:
Telephone Number of School/Setting Contact with Responsibility for EYTS Candidate/s:
Email Address of School/Setting Contact with Responsibility for EYTS Candidate/s:
For employment based routes the responsibility for DBS checks lies with the employer. Please confirm that the candidate has undertaken a DBS check / Yes
Please supply the DBS Reference Number:
How long has the candidate been employed (paid or voluntary) by you?
(please indicate exact dates of employment)
I understand that this programme requires that:
· The applicant has a timetable that will enable them to demonstrate competence against the Professional Standards for EYTS
· The school/setting provides a mentor to support the applicant for approximately 1 to 2 hours each week
· The school provides adequate feedback (observations, feedback on planning, learning and assessment) to support the applicant towards demonstrating competence against the Teachers’ Standards (Early Years)
· The applicant and the mentor are available to meet with the Leeds Trinity Link Tutor when they visit the school/setting for the purposes of assessment and moderation
· The candidate will require time in another school/setting (6 weeks)1
· EYTS candidates are required to have some experience in working within Key Stage 1 (2 weeks)1
· The candidate will require opportunity to work within 0-3 & 3-5 provision
· The final assessed block will require the candidate to have responsibility for managing the setting.
· Candidates employed in schools (except candidates in academies, independent schools and Early Years settings) must be paid in accordance with at least point one on the unqualified teachers’ scale
· No candidate will be required to perform more than 90% of the duties required by a full time Early Years teacher.
I confirm that the candidate has the support of the school/setting in applying for this EYTS programme.
Signature of Current School/Setting Employer/Headteacher
2.2 Current Reference (to be completed by your current school/setting employer)
Referee Contact Details
Name of Referee: / Address of School/Employer:Postcode:
Position (e.g. Headteacher/Nursery manager):
Email Address:
How long has the candidate been employed by you?
What is the candidate’s job title when working with you?
Does the candidate have some responsibility for planning learning opportunities? / Yes / No
Does the candidate have responsibility for managing the setting/aspects of the setting? / Yes / No
Does the candidate have responsibility for contributing to EYFS profile/assessment? / Yes / No
Comments regarding the suitability of the candidate for the EYTS Route
Please add further information on a separate sheet if you need
Date of completion
Signature of RefereeDay Month Year
SECTION 3
Employment History
Please give details of paid employment to date, in reverse chronological order (if you require more space please attach an additional sheet).
Name and Address of Employer / Dates / Duties and ResponsibilitiesSECTION 4
4.1 Mandatory Qualifications to Date
Please give details of all academic qualifications specified in this section.
Do you have a GCSE English Language or equivalent qualification?A copy of this qualification should be attached to this application form / Yes / No
Do you have a GCSE Mathematics or equivalent qualification?
A copy of this qualification should be attached to this application form / Yes / No
Do you have a GCSE Science or equivalent qualification?
A copy of this qualification should be attached to this application form / Yes / No
Do you have a UK Degree or equivalent qualification?
A copy of this qualification should be attached to this application form / Yes / No
Please attach copies of all academic qualifications specified in this section.
4.2 Professional Skills Tests in Numeracy and Literacy
Please note that from September 2012 you must have passed both Professional Skills Tests in Numeracy and Literacy BEFORE beginning the programme. You cannot be accepted onto the EYTS programme unless you have achieved passes in both skills tests.
Do you have a PASS in the Numeracy test?A copy of this qualification should be attached to this application form / Yes / No
Do you have a PASS in the Literacy test?
A copy of this qualification should be attached to this application form / Yes / No
4.3 Record of relevant Professional Development from School/Setting Employment
Date undertaken / Description / Provider of training
4.4 Other Qualifications to date
Please provide details of all your academic qualifications below, in reverse chronological order (if you require more space please attach an additional sheet).
School/College/University / Start Date / EndDate / Subject/s Taken / Results / Exam Board
SECTION 5
Personal Statement
Please explain below why you think you would be suitable for the EYTS programme, write no more than two sides of A4 in Point 12 font Arial or Times New Roman.
Please note that your Personal Statement will be used by Leeds Trinity to assess your ability to communicate clearly and accurately in Standard English.
Personal Statement:SECTION 6
6.1 Disabilities/Special Requirements
At Leeds Trinity we provide a wide range of additional support to address individual needs. Please let us know if you have a disability such as visual impairment, mental health difficulty, a medical condition such as epilepsy, ME, or if you are hard of hearing, have dyslexia or you are a wheelchair user, for example.
We would be pleased to arrange an informal meeting with you to discuss any individual support requirements.
I have a disability or dyslexia and would like an informal meetingI have a disability or dyslexia but do not require any additional support
If you have a disability or dyslexia please provide further details in the space below
6.2 Nationality and Residence details
Nationality:Country of Birth:
Country of permanent residence:
Do you need a Visa to live in the UK? Yes No
If yes, please provide your passport number:
.2 this section only if yo you hen?costs for:
/ Applicants not born in the United Kingdom please state:
Date of first entry to the UK
dd/mm/yyyy
Date of most recent entry to the UK (excluding holidays)
dd/mm/yyyy
Have you been granted Indefinite Leave to Enter/Remain in UK? / Yes/No
If you are a non-British EU National who is not living in the UK, will you have been resident in the EU for 3 years prior to the 1st of September of the year in which the EYTS period begins? / Yes No
6.3 Monitoring Information
Ethnic OriginThis section of the application form will not be used for selection purposes.
Complete this section only if your country of permanent residence is in the UK.
Please choose from the ethnic origin terms printed here the code which you feel most closely describes your ethnic origin and enter the code in the box below:
Ethnic Origin Codes
10 White
14 Irish Traveller
21 Black or Black British – Caribbean
22 Black or Black British – African
29 Other Black background
31 Asian or Asian British – Indian
32 Asian or Asian British – Pakistani / 33 Asian or Asian British – Bangladeshi
34 Chinese
39 Other Asian background
42 Mixed – White & Black African
43 Mixed – White & Asian
49 Other Mixed background
80 Other Ethnic background
SECTION 7
Declaration
DATA PROTECTION ACT 1998: The information that you have supplied will be processed and held on computer. The data may be processed for the purpose of compiling statistics, and passed to the Higher Educational Statistical Agency. By signing and returning this application form you will be deemed to be giving your consent to the processing of said data.
I consent to the processing of the data contained in my computer record. I hereby grant Leeds Trinity University College authority to release information relating to my academic status to my funding body or other agencies appropriate.
Date of completion
SignatureDay Month Year
Please send your completed application form alongside copies of:
(i) Certificates;
(ii) Professional skills test pass print outs in Numeracy and Literacy
(iii) Your letter of reference;
to: Anne Welburn
Leeds Trinity University
Brownberrie Lane
Horsforth
Leeds
LS18 5HD
0113 2837 268
Further information about the Leeds Trinity EYTS programme can be found on our website at:
http://www.leedstrinity.ac.uk/pg/14/212
If you have specific questions about the EYTS programme please contact either:
Simon Fiddes Dr Pam Jarvis
Admission Decision (OFFICE USE ONLY)
Accept Conditions
Reject
Start Date Signature of Date
Admissions Tutor
Day Month Year
Follow up needed:
Application Checklist:
Please check that the following have been attended to before sending your application in to Leeds Trinity University College. Failure to attend to any of these items will lead to a delay in your application being dealt with.
Section / What needs doing / ü/X1.1 Programme of Study / · Proposed entry date
1.2 Personal Details / · Personal contact details
· Photograph
· Nationality details
· Next of kin details
2.1 Employment details/School/Setting agreement to host EYTS candidate / · Name of school/setting contact in charge of supporting EYTS candidate
· Contact details and e-mail address for school contact in charge of supporting EYTS candidate
· DBS Reference Number
· Details of length of employment
· Signature of school support for EYTS candidate from Head teacher/ Setting Manager
2.2 Current reference / · Name and position of referee
· Contact details and e-mail address for referee
· Comments on suitability of applicant for EYTS programme
· Signature of referee
3 Employment History / · Details of paid employment to date, in reverse chronological order
4.1 Mandatory qualification to date / · Copy of GCSE English Language certificate
· Copy of GCSE Mathematics certificate
· Copy of GCSE Science certificate
· Copy of UK degree certificate (or equivalent)
4.2 Professional skills tests / · Copy of Numeracy PASS certificate
· Copy of Literacy PASS certificate
4.3 Record of CPD / · Dates and descriptions of relevant CPD already undertaken in school employment/Provider of training
4.4 Other qualifications to date / · Details of all other academic qualifications
5 Personal Statement / · Written statement on how your experience to date illustrates your meeting of the Professional Standards for EYTS (2012)
6.1 Declaration of disability/special requirements / · Ensure form is filled out fully with details of any disability or needs;
· Copies of needs evaluations are welcomed (optional)
6.2 Nationality and Residence details / · Please complete nationality details
6.3 Monitoring Information / · Please enter relevant ethnic origin code
7. Declaration / · Data Protection Act 1998 consent form – please ensure this is signed and dated
1 / Please turn over