CCDRA Form

Appendix B

CRIMINAL CONVICTION DISCLOSURE

RISK ASSESSMENT (CCDRA) FORM

To be completed by the Collegewith the applicant (and/or external agencies as required) to support an application to study or to review an enrolment at The Manchester College when there are criminal conviction/s or where sentencing is pending. Where appropriate the process will also be followed where an applicant/learner is on bail depending on nature of bail conditions.

Forms are to be completed electronically and password protected as per Safeguarding Procedure.

All forms are to be emailed to the Head of Department Student Experience (Safeguarding)

Applicant information:

Name: / DOB:
/ /
Address: / Contact Number:
Course applied for or current enrolment: / Mobile:

For external agencies:The college needs as much information as possible to undertake this risk assessment accurately. We appreciate the need for Data Protection and it is the agency’s responsibility to ensure that the applicant has provided informed consent to share sensitive and personal information (where required) and to ensure all information is shared legally.

Applicant present at review meetingYes No

If no, explain reasons:

______

People present at meeting (if applicable) including TMC staff:

Name: / Role: / Tel / Email

People who have contributed to the Risk Assessment process:

Name: / Role: / Tel / Email / How information shared e.g. phone, Egress

Details of disclosure:

Offence / Date of conviction/sentencing / Penalty / sentence
Bail Conditions:
Are there any actions required to support participation in College?
e.g. supervision, reviews, partnerships
Who might be at risk? – The student her/himself, other students, staff, public, nursery?
Are you currently on a: / Tagging Order / Yes / No
Home detention curfew / Yes / No
Sex Offenders Register / Yes / No
Do you have any history of the following: / Arson / Yes / No
Offences against children/vulnerable adults / Yes / No
Violence against a person / Yes / No
Are you currently : / Under bail conditions / Yes / No
Pending a court hearing / Yes / No
Do you have a Learning Disability / Difficulty?
If yes, please give details : / Yes / No
Other comments/actions:
Risk / Level of risk/likelihood (low, medium, high) / Actions/measures to manage risk / Revised level of risk/likelihood
Outcome of risk assessment including conditions:
Additional Information

Information sharing by other professionals

I confirm that the information has been shared with the informed consent of the applicant (as required).

Name (Please Print):______Signature: ______

Date: ______

Applicant Declaration

I have read the information provided on this form and understand that the College needs this information to ensure I am provided with the appropriate advice and guidance. I confirm that I give my consent to The Manchester College to use this information to risk assess my application. I understand that the outcome of the risk assessment process may be that I am not offered a place at The Manchester College or that my current place at The Manchester College may be withdrawn. I understand that I have the right to appeal the decision made following the Risk Assessment process but understand that the college’s decision following appeal is final. I understand that this information will be managed and stored securely.

I give consent for the sharing and /or the exchange of information with relevant The Manchester College staff and with external agencies e.g. YOT/Probation and social services as/when required.

Name (Please Print):______Signature: ______

Date: ______

Summary discussion with Curriculum area (as appropriate):

Assessment outcome

Continue without conditions / support:

Continue with conditions:

Unsuitable for course:

Unsuitable for college:

Additional Comments:

Outcome agreed by:

Name: / Role: / Date / Comments