Public Sector Supported Employee Or Consultant (Tick Box)

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SQA Road Safety Application Form
Candidate Details (for SQA use)
Title
First Name/s
Surname
Date of Birth
House No./Name
Road/St Name
Town/City
County
Post Code
Home Tel:
Mobile:
Working email address:
Personal email address:
Particular requirements/additional needs
Where to send the certificate
Other address for certificate
RoSPA Membership number:
Employment Information
Employers Name:
Job Title:
Work Mailing Address:
Postcode:
Telephone
Work Mobile:
Fax:
Please provide a brief description (maximum 150 words) of your role specifying the percentage of Road Safety in it.

Sponsored Placement: To qualify for a sponsored or discounted position, this section should be completed by the Road Safety Lead for your Employer/Sponsoring Body

Supported Placement Applied For:

Public Sector Employee Free of charge (tick box):

Public Sector Supported Employee or Consultant (tick box):

SPONSORING AGENT: Please provide in no more than 200 words details of the candidates role or proposed role which would be supportive of an Assisted placement.

Sponsor Name
Sponsor Role
Sponsor Signature

Table of Costs

COSTINGS
Public Sector Road Safety Professional * / Public Sector supported employee or supported consultant ** / Any individual in the Private Sector
Individual participating in Core qualification ( five base units plus one additional) / Free of charge / £1550.00
(50% reduction) / £3100.00
(10% to RoSPA Members)
Individual undertaking Stand Alone Unit / Free of charge / £310 / £620
(10% to RoSPA Members)
Individual participating in more than two specialist Units / Free of charge / 50% Discount / Full cost at £620 per unit with 10% discount.
(20% discount to RoSPA Members)
All prices are subject to VAT at the current rate (20% at June 2014)
Delivery of concessions is fully supported by Transport Scotland and RoSPA.

* Individuals employed within the public sector, where at least 50 per cent of their role is dedicated to road safety education/promotion, road engineering or enforcement. All applications should be endorsed by organisational road safety lead.

** Any individual seconded or undertaking a temporary posting or consultancy within a Public Sector body for a period of at least nine months, in a post directly relating to road safety education/promotion, road engineering or enforcement. All applications should be endorsed by organisational road safety lead.

Please send your completed application by post or e-mail to :
RoSPA Scotland - SQA Road Safety Delivering the Framework
Livingstone House
43 Discovery Terrace
Heriot-Watt Research Park
Edinburgh
EH14 4AP
Email:
For Office use only:
Unit Title:
Unit date:
Candidate enrolment number
date of registration with SQA
assessor(s) name(s)
internal verifier(s) name(s)
progress records, including unit accreditation and unit completion date