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UKCC LEVEL 3: RFU ADVANCED COACHING AWARD
APPLICATION FORM FOR 2018/19

Please complete this application form fully and submit along with the following:

Submission Details - (Please tick once document is ready to submit with this application) / √
1) / Submission of a 15-20 minute long video clip, which shows you coaching “Go forward and support” from phase play. Please see the Application and Admission Details document for full requirements.
2) / Written reflection of the videoed session (500 word limit).
3) / Written confirmation (email or letter) from your club/school that you are Head Coach/Programme Leader in the XV a side game – this is essential if you are to demonstrate all competences.
4) / Evidence of attendance at three or more of the following Advanced Coaching CPD series, comprising at least two from: Planning & Periodisation, Player Profiling and Game Planning, plus one from: Goal Setting and Performance Analysis. You can find details of current courses online at www.englandrugby.com/my-rugby/courses/search.
5) / Completed Player Profiling task using the template provided for 4 positions (Loose Head Prop, Number Eight, Inside Centre and Fullback). Please ensure you are using the task that has been set for 2018 and not a previous template.
6) / Evidence that you have completed the HEADCASE ONLINE CONCUSSION EDUCATION COURSE. Please see the Application and Admission Details document for full details.
7) / Full Coaching CV.

Please complete all boxes. Applications will not be accepted if they are incomplete or illegible.

1. Personal Details

First name / Surname
Date of Birth
(DD/MM/YY) / Gender / Age
Full Address
Postcode
Home Tel. No. / Mobile
Email Address
2. Course Details
Course Name / UKCC Level 3: RFU Advanced Coaching Award
Preferred Course Venue (please delete as applicable and only apply for one of the venues) / North Course
Manchester
July 2018 – Dates and Venue TBC / South Course
Bristol
(27th, 28th and 29th July 2018) / Pro Players Course
June 2018 – Dates and Venue TBC

3. Name and address of Club / School /CB

Name and address of Club/ School/CB where you intend to coach during the Level 3 process
4. Ethnicity / Disability
Ethnicity
I would describe my ethnic origin as:
Disability This will help course staff to support your learning needs, where relevant. / Do you consider yourself to have a disability?
Yes* / No / If Yes*, what is the nature of your disability? (delete as applicable) / Hearing Visual Learning Mobility
Dyslexia
Other
Comment / Yes / No
Yes / No
Yes / No
Yes / No
Yes / No
Yes / No

I confirm that I have read, understand and agree to the details contained in the Application and Admissions Details of the Level 3 coaching course:

Signed / Date

Financial Implications for Applicants Not Attending Courses

If an applicant does not attend the course or gives less than 48 hours’ notice then no refund will be given.

If an applicant gives between 2 and 14 days’ notice, the applicant can be relocated to another course providing they pay a £25 administration charge, there will be no refund.

If an applicant gives more than 2 weeks’ notice, they can be offered either relocation to another course at no charge, or a refund of 75% of the course cost.

Nature of the Coaching Courses

Attendance on coaching courses will require some practical involvement to assist the coaching process. Please raise any issues that could affect your health with either the administrator or your Coach Educator on arrival at the course.

Version: October 2017