Application form

for application to the early years teacher status(EYITT)

1. Personal Details
Title Ms/Miss/Mrs/Mr etc / Surname/family name (BLOCK CAPITALS)
First name(s) / Previous surname, if changed
Permanent address
Postcode / Correspondence address
Postcode
Daytime telephone number / Evening telephone number / Mobile telephone number
Email address
Gender: Male (M) [ ] Female (F) [ ] / Date of birth
2. Route Applying for (please tick) / 
Graduate Entry
Graduate Employment Based
Assessment Only
3. Fee status
Country of birth / Nationality
Country of permanent residence
Have you lived in the UK/EU for the whole of your life up to the present day: Yes [ ] No [ ]
If No, please state date of first entry into the UK/EU
Name of organisation expected to pay your fees
(e.g. employer, self-fundingetc)
4. Early Years Teacher Status Self-Evaluation
This self-assessment is to help potential trainees that are working in early years identify the most appropriate pathway to become an Early Years Teacher. Think about the work you do within your setting and tick the box that best fits your own situation.

REQUIREMENTS

/ YES / NO
  1. I am physically and mentally fit to work as an Early Years Teacher

  1. I do not have a criminal background that might prevent me from working with children, or as an Early Years Teacher, and have not previously been excluded (disqualified) from working with children

  1. I hold a degree in Early Childhood Studies or an equivalent graduate qualification(s)

  1. I have achieved GCSEs at grade C or above (or recognised equivalents in English Language, Mathematics and Science)
Please note: Level 2 Literacy/Numeracy certificates are not equivalent to GCSE English and Maths.
  1. I have successful passed the DfE Literacy Skills Test

  1. I have successful passed the DfE Numeracy Skills Tests

EXPERIENCE

/ Frequency
Yes / Occasionally / No
*I work with children in the 0-3 year range
*Iwork with children in the 3-5 year range
*I have experience with working with children in the 0-3 age range
*I have experience with working with children in the 3-5 age range
*I have experience of Key Stage 1 and Key Stage 2
*I manage the work of other practitioners
*I know and understand the implications of the EYFS Outcomes Frameworkfor children 3-5 years
*I know and understand the implications of the EYFS Outcomes Framework for children 0-3 years
*I am involved in leading the delivery of the EYFS within my setting
*I am involved in the managing the delivery of the EYFS within my setting
*I am involved in monitoring the work of other practitioners
*I work with other professionals beyond the setting in my work
*I use literacy (including synthetic phonics) numeracy and ICT skills in my work
*I work collaboratively with other adults in my setting
*I understand how to assess and monitor children’s progress
*I work in partnership with parents / carers to improve outcomes for children
5. Employment status(please tick) / 
I am currently in paid employment in an Early Years setting
E.g. School, Nursery etc.
I am currently unemployed or not working in an Early Years setting
Employment details: (If Applicable)
Organisation
name:

Your Job title:
After School Club / Nursery School
Childminder / Primary School with nursery & reception classes
Full day care
– including Children’s Centre / Primary School with reception but no nursery classes
Holiday Club / Sessional provider
Other (please specify)
Type:
Please tick
Independent / Private
Maintained / Voluntary
Not applicable
Sector:
Please tick

Head teacher/
Manager’s name:

Setting Address:
Work telephone:

Email:
Local Authority area of employment:

Start date of current employment:

How many hours are you contracted for per week at this setting?
Do you have qualified teacher status? Yes No  DfES Number ______
If yes is your QTS EARLY YEARS  PRIMARY  SECONDARY 
6. Work experience

Please give details of work experience, training and employment. Continue on a separate sheet if necessary

Organisation / Job title / Main duties / From (MMYY) / To (MMYY)
7. Last two educational establishments at which you studied
Name and address of establishment / Course / From / To / Full or part time
8. Education and Qualifications
Qualification / Subject / Dates / Results
Month / Year
Is English your first language? Yes [ ] No [ ] If No, what is your first language?

Please note: Level 2 Literacy/Numeracy certificates are not equivalent to GCSE English and Maths.

9. Disability/Specific Needs
All applicants are required to tick the appropriate disability code. The codes for disabilities, specific needs and medical conditions are:
[ ] A – None
[ ] B–You have a social/communication impairment such as Asperger’s syndrome/other autistic spectrum
[ ]C – You are blind or have a serious visual impairment uncorrected by glasses
[ ] D – You are deaf or have a serious hearing impairment
[ ] E – You have a long standing illness or health condition such as cancer, HIV, diabetes, chronic heart disease, or epilepsy
[ ] F – You have a mental health condition, such as depression, schizophrenia or anxiety disorder
[ ] G – You have a specific learning difficulty such as dyslexia, dyspraxia or AD(H)D
[ ] H – You have a physical impairment or mobility issues, such as difficulty using your arms or using a wheelchair or crutches
[ ] I – You have a disability, impairment or medical condition that is not listed above
[ ] J – You have two or more impairments and/or disabling medical conditions
10. Criminal Convictions
Please refer to the guidance notes regarding the definition of criminal convictions.
Please note that your offer of a place on an Early Years Teacher Statusroute will be conditional to you having an enhanced DBS clearance. If you have joined the DBS update service, please indicate below.
I have joined the DBS update service
If you have a relevant criminal conviction, enter Y or N in the box [ ]
11. Ethnic origin (to be completed only if country of permanent residence is in the UK)
What is your ethnic group? Choose a section and then tick the appropriate box to indicate your cultural background
Please tick:
White / Black or Black British / Asian or Asian British / Mixed
British / Caribbean / Indian / White and Black Caribbean
Irish / African / Pakistani / White and Black African
Other White Background / Any other Black background / Bangladeshi / White and Asian
Please specify: / Please specify: / Any other Asian background / Any other mixed background
Please specify: / Please specify:
Chinese or other ethnic group
Chinese
Any other background
Please specify:
12. Personal statement
You must provide a personal statement to support your application to study on this course. Please refer to the guidance notes for further assistance. Note that your application will not be processed without a personal statement.
13. Reference
The University requires one reference in support of your application. Please provide details of your referee below. Your reference is either to be completed on the separate document and included with your application form or sent separately as soon as possible. Please note that it is your responsibility to contact your referee. We are unable to make a decision about your application until we receive your reference.
Name
Position
Address
Telephone number
Email address
14. Declaration

I understand that I am responsible for payment of all tuition fees. I agree to comply with the statutes, ordinances, bye-laws, regulations, rules and conditions of the University of Chester for the time being in force, including Health, Safety and Disciplinary Regulations. I agree that all ideas, materials or work produced by me and submitted as part of the requirements of my programme of study and all intellectual property rights therein will become the absolute property of the University of Chester, unless specifically agreed to the contrary.

Data Protection Act 1998

I consent to the University of Chester processing personal data contained in this form, or other data which may be obtained from me or others, including details of academic performance, learning support needs, disciplinary matters, destinations and comments on quality, closed circuit TV and video recording on university premises and holding my photograph which is used on the student ID card for any purpose connected with my studies, my health and safety, implementation of the Rules, to provide data that the University is required to hold or supply to the Higher Education Statistics Agency (HESA) or for any other legitimate reason. I consent to the disclosure of such information for academic administration purposes, in response to requests for references relating to continuing education, training or employment, for implementation of the Rules or in relation to council tax matters. I understand that HESA pass data to organisations that need it to carry out their statutory functions connected with funding higher education. I am aware that I may request a copy of information held about me on request and on payment of the appropriate fee and that further information regarding HESA can be found on IBIS.

Signature: ...... Date: ......

Please keep a copy of this form for your records and return the original to: Helen Davis, ITTADMISSIONS, UNIVERSITY OF CHESTER, RIVERSIDE CAMPUS, CHESTER CH1 1SL. Please enclose a reference with your application or contact your referee to request they send the reference to Undergraduate Admissions.

Please refer to the Application Notes for Guidance for further information. If you have any queries, please contact ITE Admissions - Tel: 01244 512627Email:

FOR OFFICE USE ONLY:
Academic Decision: Reject [ ]Accept [ ]
Conditions of offer:
Signed: ...... Date: ......
Qualifications confirmed by: [ ] Certificate produced by student [ ] Other......
Signed: ...... Date: ......