APPLICATION FOR CIH DISTANCE LEARNING
COURSE CIH MEMBERSHIP
Please complete the form and send it back to the CIH distance learning team byemail, post or fax(contacts details given at the end of this form). If you require any help filling in this application form or would like further information please contact us on Tel: 024 76851789 Fax: 024 76694209 Email:
PERSONAL DETAILS
Surname: / Home address:Postcode:
Forenames:
Title:
Home Tel no:
Designatory letters e.g. BA, CIHM
/ Home Email Address:
Have you lived in the UK or EU for the last three years?
(if no our delivery partners will require further information and you may need to pay the overseas student rate to them)) / Yes [ ] No [ ]
EMPLOYMENT DETAILS
Organisation name:Work Address:
Postcode: / Job Title:
Role Level:
Role Type:
Work Tel no: / Work Email address:
Please indicate which your preferred contact telephone number is: Home Work
Please indicate which is your preferred contact email address Home Work
For all courses except Level 2, your course materials will be made available on the Moodle website prior to the start of your course and you will be sent more details. For Level 2 course materials will be sent in hard copy, workbook format.PARTNERSHIP CENTRES
The CIH Distance Learning Centre works with FE and HE colleges to deliver courses.Students in Scotland studying the Level 3 Award, Certificate or Diploma in Housing Practice and the Level 4 Certificate for the Housing Profession, will be allocated to Dundee College.
Students from England studying the CIH L3 Diploma in Housing Practice will enrol with CHS.
The MSc Housing Studies, Professional Diploma in Housing and Sustainable Communities & MSc top up are delivered by CIH in partnership with De Montfort University (Leicester).
QUALIFICATIONS
Please list your qualifications (GCSE, O Levels, A Level, Degrees etc) – photocopies of certificates must be attached.Please include any qualifications you have through CIH
Dates Studied / Subject / Examining Body / Level / Grade (if known)
Useful contacts if you have difficulty locating these:
OCR 01223 553 998 can provide a statement of results.
Edexcel 0870 240 9800 can provide a duplicate certificate.
If students need to convert a foreign qualification contact UK NARIC Tel: 0870 990 4088 -Please note there is a fee attached to the service for any of the above.
CAREER HISTORY
Please tell us about your employment history beginning with your current employer. If you are currently working in a voluntary capacity in housing, please specify the organisation you work for and your role.Date / Employer / Position
COURSE DETAILS
Which course do you wish to apply for? The following is a list of the courses currently being offered by CIH Distance Learning. Please tick “√” the box before the full title of the course you are applying from the list below:Level 2 Certificate in Housing Practice
If you have chosen this course, please indicate if you are currently working in housing or a related sector:
Yes: I am currently working in housing
No: I am currently not working in housing
Level 3 Award in Housing Practice – 2 Modules
Level 3 Certificate in Housing Practice (Supporting Independent Living) – 4 Modules
Level 3 Certificate in Housing Practice (Managing Housing Services) – 4 Modules
Level 3 Certificate in Housing Practice (Housing Advice and Information) – 4 Modules
Level 3 Diploma in Housing Practice(Supporting Independent Living) – 5 Modules
If you have chosen the above pathway please circle ONE of the following modules to complete:
Independent Living for Older People OR Housing and Younger People
Level 3 Diploma in Housing Practice (Managing Housing Services) – 5 Modules
Level 3 Diploma in Housing Practice (Housing Advice and Information) - 5 Modules
Level 4 Certificate in Housing Practice (Managing Neighbourhoods)
Level 4 Certificate in Housing Practice (Support for Independent Living)
Level 4 Certificate in Housing Practice (Planning and Development)
Level 4 Certificate in Housing Practice (Governance)
Level 4 Certificate in Housing Practice Year 1 (leading to Diploma Year 2 by Blended Learning, delivered locally, please state preferred location { }
Please note : The course fee is for 1 Year of study you will apply for Level 4 Diploma year on completion of this year
Level 4 Certificate/Diploma in Housing Practice(intensive)
Level 4 Certificate for the Housing Profession (formerly Graduate Conversion course)
Level 2 Certificate in Housing Maintenance
Level 3 Certificate in Housing Maintenance
Level 4 Certificate in Managing Responsive Repairs
Level 4 Diploma in Housing Maintenance Asset Management/Housing Development
MSc top up(for students who have already completed a Postgraduate Professional Diploma course)
Professional Diploma in Housing and Sustainable Communities(PDHSC) - Year 1
MSc Housing Studies Year 1
You are required to choose one of the following options.
Regeneration and sustainable neighbourhoodsCustomer and Neighbourhood Services
HOW DID YOU HEAR ABOUT US?
Please tick one of the following that is most applicable to let us know how you heard about this course:
Source of registration:
- Advert
- College Referral
- Event
- Flyer
- Press
- Website
- Word of mouth
- Other
When do you want to start this course? We have 2 annual intakes for the above courses and please state below the intake and the year you wish to start by ticking the box below:
August 2012for MSc, MSc Top up and Professional Diploma courses (closing date
10 August 2012)
September 2012 for all Level 2, Level 3 and Level 4 courses (closing date on 28 September
2012)
March 2013 for all CIH distance learning courses
REASONS FOR APPLYING FOR THIS COURSE
Please answer the questions below, they have been designed to help you think about your personal objectives and how you are planning to approach your study for the course. The answers also give us a chance to find out a bit more about you; we will share this information with your tutor to help them to provide you with the right support.
1. Please write up to 300 words in support of your application, telling us why you want to do the course and to support your eligibility for the qualification you have chosen. (see for eligibility criteria.2. All students on our courses are studying part-time, often combining this with work and family commitments. Please read the information pack for your chosen course and write up to -100 words on how you plan to effectively manage your time to allow the appropriate hours of study and production of written assignments.
3. What experience and skills do you have (including IT skills)?. Please provide up to 200 words for this question.
4. How do you plan to use the learning from this course, how to you think it will support your career in the future? Please provide up to 200 words for this question.
We may come back to you for more details on the above, especially if we need to clarify your eligibility for the course you have applied for.
METHOD OF PAYMENT AND HOW TO RETURN THIS FORM
Self financing studentsEither
Return the form by email/fax indicating that you will be sending a cheque and a hard copy of this form in the post (please note we will not be able to process your application form until we have received your cheque)
Or
Return the form by email/fax and ring us with credit card details – 02476 851789. Please note that we accept Mastercard/Visa/Switch/Maestro.
Sponsored students
Either
Return the form by email, and send a letter of authority (this should include the name of the student, the amount to be invoiced and the address for the invoice to be sent to) together with a hard copy of application form in the post (please note we will not be able to process your application form until we have received your letter of authority)
Or
Return the form by post completing the below declaration by employer or including a letter of authority (this should include the name of the student, the amount to be invoiced and the address for the invoice to be sent to).
REFUND POLICY
This policy below will be strictly adhered to. All withdrawals from the course must be made in writing to the CIH Distance Learning Centre.
Stage / PolicyStudent has not attended Induction/enrolled with a centre. / Full refund
Student has not attended Induction day or filled in Centre enrolment form. / Full refund
Student has attended Induction day/enrolled with centre and it is within 2 months of the closing date of 28 September 2012 / Full refund minus admin fee of £100
Student has attended Induction day and it is more than 2 months of the closing date of 28 September 2012. / No refund
In addition, if you fail to attend any booked course events - except for mitigating circumstances and with prior notice where possible - you could be liable to pay any costs and/or expenses incurred to CIH in delivering the course events.
DECLARATION
Declaration by employerI hereby declare that the course fees will be paid for this applicant upon receipt of an invoice. If you are only paying part of the course, can you please state clearly what percentage this is.
Employer Name / Telephone number
Address for invoicing / Authorised by (signature)
Postcode / Authorised by (please print)
Declaration by applicant
I certify that the information given in this form is correct (please complete if faxing or posting this application form).
Where fees are paid by your employer or a sponsor, CIH will provide details of your progress to them.. Please tick the box if you DO NOT agree to this.
By signing this form, you will accept that:
- all information as published here or elsewhere in our promotional materials is correct at the time of printing. The CIH and its partnership institutions reserve the right to change any information including contents of the courses and assessment details where and when necessary within the requirements of the syllabuses;
- you have read the course information and understand the level of time commitment needed to complete your studies and produce written assignments within the given deadlines. You have read and understood our refund policy above.
Signature / Date
Please send your completed application formby e-mail, post or fax to:
Distance Learning Centre, Chartered Institute of Housing, Octavia House, Westwood Way, Coventry, CV4 8JP.
Tel: 024 76 851789 Fax: 024 76 694209 Email:
If you do not receive confirmation of receipt of your application form within 2 weeks of sending it please contact us.
CIH MEMBERSHIP
You are entitled to be a CIH member as part of registering for a CIH qualification.
Are you already a CIH Member? Y/N If yes, please indicate your membership no. ______
If you are not currently a CIH member, we will register you automatically and provide you with member benefits designed to support you in your role and your studies with access to a range of journals, including your own copy of the sector’s leading magazine Inside Housing, as well as newsletters, and website resources and discounts on other CIH products and services. Further information about how to access the full range of services on offer to you will be sent to you as part of your membership welcome pack when we register your membership.
In order to provide proof of the circulation figures provided for Inside Housing pleasesign below to formally request your copy.
Signature: / Date:Membership Terms & Conditions
A full copy of the CIH Charter & Byelaws and Code of Conduct can be found at:
In becoming a CIH member you are undertaking to observe the provisions of the Charter & Bylaws, to abide by the CIH Code of Professional Conduct, and to contribute, if able, to the activities of the Institute and its Regions.
Signature: / Date:DATA PROTECTION STATEMENT
In making this application your contact details will be stored on our database. As a member of the CIH we will use these details to provide you with information and benefits relevant to your membership. From time to time membership details are passed to third parties for the sole purpose of providing you with products and services that you receive as part of your membership such as Inside Housing magazine.
The CIH does not sell its membership lists to any other organisation for marketing purposes. You can manage the information that we provide to you by opting in or out of receiving specific types of information by registering and logging in to your online account at
MENTOR
A mentor is someone from your employing organisation or voluntary placement who can offer you the support, guidance and advice you will need in order to complete your studies at a practical level. It could be for example, your supervisor, line manager or a senior colleague who you think can act as a ‘sounding board’, or you feel comfortable to turn to for sharing ideas or offering practical help. We strongly recommend you have one in place before you start your course.
If we need to contact your mentor, we will always seek your permission first.
Your Mentor
Name / Preferred Telephone no:Address
Email address (please write clearly)
Postcode
CIH Equality and Diversity Monitoring
The CIH is committed to ensuring that its services are accessible to everyone regardless of race, gender, ability, religion, sexual orientation or age. The information you give on this form will help us comply with our policy of ensuring equality in our services to you.
We recognise that some people may regard some of this information as personal and we have, therefore, included an option in most questions for “prefer not to say”. You do not have to complete all of this form but it will help us improve our services if you can complete as much as possible and return the form.
All information CIH collects around equality and diversity will be treated confidentially in accordance with the Data Protection Act and will be stored on the CIH database. Access to this information will be restricted to staff involved in the processing and monitoring of this data. It will be used to provide statistical information only.
Please give your consent below for your information to be stored and used in this way.
Signed:______Date: ______
A. Age
What is your date of birth?
Prefer not to say
B. Disability
The Equality Act 2010 defines a person as disabled if they have a physical or mental impairment, which has a substantial and long term effect (i.e. has lasted or is expected to last at least 12 months) on the person’s ability to carry out normal day-to-day activities.
Do you consider yourself to have a disability according to the terms given in the Equality Act 2010?
Yes / No / Prefer not to sayIf you have answered yes, please indicate the type of impairment which applies to you. If you experience more than one type of impairment, please tick all the types that apply. If your disability does not fit any of these types, please mark ‘Other’ and specify.
Physical/mobility impairment, such as a difficulty using your arms or mobility issues which require you to use a wheelchair or crutchesVisual impairment, such as being blind or having a serious visual impairment
Hearing impairment, such as being deaf or having a serious hearing impairment
Mental health condition, such as depression or schizophrenia
Learning disability/difficulty, such as Down’s syndrome or dyslexia or a cognitive impairment such as autistic spectrum disorder
Long-standing illness or health condition, such as cancer, HIV, diabetes, chronic heart disease or epilepsy
Other (Please specify below)
If you have filled in Part B of the above Section, it is important that you read and understand the CIH Learning Support Arrangement which we will send you to sign and return as part of your application to CIH Distance Learning Centre. Please note that we will notbe able to finalise your enrolment until we have received your signed copy of the Arrangement document.
C. Ethnic group
(These are based on the Census 2011 categories, and are listed alphabetically)
Asian, Asian British, Asian English, Asian Scottish, Asian Welsh or Asian Irish
Indian / Pakistani / BangladeshiChinese / Other Asian Background / Please state:
Black, Black British, Black English, Black Scottish, Black, Welsh or Black Irish
Caribbean / African / Other Black BackgroundPlease state:
Mixed
White & Black African / White & Black Caribbean / White & AsianAny other Mixed/multiple ethnic background / Please state:
Other
ArabOther
Please state:
Prefer not to say
White
EnglishWelsh
Scottish
Northern Irish
British
Irish
Gypsy or Irish Traveller
Any other White background
Please state:
D. Gender
Male / Female / Prefer not to sayDo you identify as transgender?
For the purpose of this question “transgender” is defined as an individual who lives, or wants to live, in the gender opposite to that they were assigned at birth.
Yes / No / Prefer not to sayE. Religion/belief
Buddhism / Judaism / Other (please specify below)Christianity / Islam / Prefer not to say
Hinduism / No religion / Sikhism
F. Sexual orientation
Bi-sexual / Heterosexual/straight / Gay manGay woman / Other (specify if you wish) / Prefer not to say
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