Application for PG Certificate: The National Award for SENCO
Indicate Local Authority/and/or location where you work/would like to attend
Cornwall: Bodmin.
Devon/Babcock: Exeter.
Plymouth: Plymouth University.
Somerset: Ilminster.
No LA preference for where to attend.
If there is no Local Authority place in your first choice please indicate your second choice.
Personal Details
surname: / forename(s):
title (Dr, Mr, Mrs, Ms) / previous surname/ maiden name
male / female / date of birth
home address: / country of domicile:
Nationality:
town/ county: / email:
postcode: / telephone:
Current Employment
name of employer:
contact details of employer, phone: email:
address:
town/ county: / postcode:
Title of post held / Phase: (ie Early Years/Primary/ Secondary/Special/PRU/Secure Unit/ Other)
Do you hold Qualified Teacher Status (QTS)? / YES / NO / If YES please underline the award in the entry below that gave you QTS and enter your Teacher Reference Number
Number of years teaching experience / Teacher Reference No / /
Qualifications gained after leaving school
title / awarding institution or organisation / dates
Professional Experience
Please include main teaching and non-teaching posts and in the first column any specialism and posts of responsibility
post / employers name and address / dates
Are you currently working as a SENCO? / Yes / No
When were you appointed as a SENCO? / Date:
Do you hold a permanent contract or fixed term contract (1 year or greater) / Yes / No
Are you intending to become a SENCO / Yes / No
What is your current role?

Personal Statement giving your reasons for wishing to join the course.

This information helps us to help you so please elaborate on (i) personal interests in particular subjects and issues;

(ii) professional development in key areas; (iii) the challenge of a new post; (iv) particular needs of your school

Which Award are you applying for? Please tick one option

The National Award for SEN Coordination
This is a Department for Education approved postgraduate qualification at Masters level for teachers in the role of special educational needs co-ordinator (SENCO). New-to -role SENCOs in maintained mainstream schools must attain the Award within three years of their date of appointment as SENCO. To achieve the National Award teachers must successfully meet all the SENCO Learning Outcomes and successfully complete two Masters level assignments. The award is validated at Masters Level and provides 60 credits. In order to complete the full award Teachers who are not SENCOs must have access to an appropriate educational setting, which is agreed with the SW Consortium/Programme Leader, and will allow an opportunity to fulfil the NCTL Learning Outcomes. This accredited outcome can be used to contribute 60 credits towards an MA
------PGcertificate Inclusive Education (Non-National Award status)
Teachers who are not SENCOs may not be able to achieve all of the SENCO Learning Outcomes in the first instance. If you are not a SENCO you should discuss this aspect of the course with the programme leader. You can still achieve the award of PGCert Inclusive Education which comprises the two credit bearing modules of the National Award but not the additional portfolio requirement. You will be taught alongside attendees of the above programme but would not achieve the National Award status until you completed the Portfolio element which could possibly be achieved at a later date. This accredited outcome can be used to contribute 60 credits towards an MA


English Language Requirements

Is English your first language? / YES / NO
Please list any formal English qualifications (IELTS, TOEFL etc) including examining body, score and date taken:

and include copies of test certificates with this application.

Criminal Convictions

Do you have a criminal conviction for offences of a violent or sexual nature against the person, and/or a conviction involving commercial drug dealing or trafficking?

YES / NO
Sponsorship Details (if applicable)
Please provide details of any sponsor
Sponsor Name / Full address for invoice (including Self):
For the attention of:
Please enter details of any sponsors to be invoiced for your tuition fees. If left blank we will presume you are self-funding and invoice you for any fees due.
Emergency Contact Details
Contact Name / Address & Telephone Number (if different from Home Address)
Relationship
Ethnicity & Disability Information (please circle appropriate number for each section)
As a requirement of the Race Relations Act (2000) we need to know your ethnic origin for the purpose of monitoring equality of opportunity to all ethnic groups, highlighting possible inequalities and enabling the implementation of action to remove any barriers and discrimination. This information will be treated as STRICTLY CONFIDENTIAL for Disability Assist Services or Equal Opportunities purposes and will not be taken into consideration for your application.
ETHNIC ORIGIN
11 White – British
12 White – Irish
19 Other White Background
21 Black or Black British Caribbean
22 Black or Black 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 or other ethnic background – Chinese / 39 Other Asian Background
41 Mixed – White and Black Caribbean
42 Mixed – White and Black African
43 Mixed – White and Asian
49 Other Mixed Background
80 Other Ethnic Background
90 Not Known
98 Information Refused / DISABILITY
A No Disability
B You have a social/communication impairment such as Asperger’s syndrome/other autistic spectrum disorder
C You are blind or have 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 physical impairments 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

Data Protection Act 1998

The information which you give on your application form will be used for the following purposes only: A) to enable your application to the University to be considered; B) To enable the University to compile statistics, or to assist other organisations or individual research workers to do so, provided that no statistical information which would identify you as a person will be published; C) To enable the University to initiate your student record.

Expectations and Entitlement

By registering on this University of Plymouth programme you are agreeing to undertake professional development at Masters level. You are entitled to appropriate tutor support, full access to University of Plymouth libraries and electronic library resources and online research support materials – further details are available at www.plymouth.ac.uk/imp

Additional Information

Student Declaration: I certify that the information given on this form is correct to the best of my knowledge. I have received a Notice on Data Protection which explains the use made by the University of student personal data. I agree to abide by the Institution’s Regulations and Code of Conduct and I understand that I am assigning certain Intellectual Property Rights (IPR) to the University. The Regulations, Code of Conduct and details of IPR assignment appear in the Student Handbook available at www.plymouth.ac.uk/studenthandbook
Signature ...... Date ......
Please note that on submitting this form by email you have accepted these terms and agree to this declaration.
Fee Details (Office Use Only)
Fee Region
Debtor Flag
Total Fee for Academic Year:
Who will pay the fees? (circle as appropriate) / If no fee payable please give reason:
(Paid in previous year/Board Purposes Only/Other)
Self / SLC / Sponsor / More than one
Please provide details of amounts to be paid: / Fee Reduction Applicable? Yes / No
Payer / Amount / Payer / Amount / Reason for Reduction:
Amount of Reduction (£/%):

PLEASE COMPLETE THIS APPLICATION FORM AND RETURN BY EMAIL TO