National PSHE CPD Programme

Application Form

Levels 4, 5, 6

Training and Assessment provided by Babcock 4S

30 Credits – Accreditation through the University of Roehampton-London

Section One: Personal Details
Please ensure that you enter your full name as you would like it to appear for registrations and certification purposes.
Title: / Name: / Surname: / Gender: / Ethnicity: / Nationality:
Date of Birth: / Disability: / Email: / Telephone:
Home Address: / Home / Overseas: / Domicile if different from Home address:
Please note: If your personal details change, please advise the Head Office.
Section Two: OrganisationDetails
Organisation/School/
Establishment Name / Organisation/School/
Establishment telephone number
Organisation/School/
Establishment Address / Organisation/School/
Establishment email
Role: / School Phase/type if applicable: 
 infant
junior
primary
secondary
special/PRU
independent
 cross phase / Specialism: 
RSE (Relationship & Sex Education)
 DE (Drug Education)
EHWB (Emotional Health & Wellbeing)
 EWB & FC (Economic Wellbeing & Financial Capability)
SS (Staying Safe)
Please indicate the area of PSHE most relevant to your role
Local Authority
Section Three: Pre-requisites:
The PSHE CPD Programme is designed for teachers, Teaching Assistants, HLTA, community nurses, police officers, fire and safety officers and other professionals involved in the delivery of PSHE education in schools and other settings. Applicants should have opportunities to work with children and young people and the support of the school or their organisation.
The Programme aims to improve the competence and confidence of those delivering PSHE.
Please tick that you have understood the above. 
Section Four: Sex Education Forum Free Membership
Participants applying before 1st January 2018 will be eligible to apply for discounted network membership of the Sex Education Forum.
If you do not wish to take advantage of this please tick this box.
Section Five: Programmes and Levels
Please indicate which location you would like to attend in order of preference:
 London  Surrey Essex Leicestershire Other (please state)
Also please visit our website:
Programme Title: National PSHE CPD: Effective Teaching & Learning in PSHE Education
Module Title and Level (Teachers and Nurses study at Level 6, for PSHE professionals in other roles Level 4, or Level 5 is most appropriate).
 Level 4: Certificate of Professional Practice in PSHE Education
 Level 5: Certificate of Professional Learningin PSHE Education
 Level 6: Certificate of Professional Development in PSHE Education
Please indicate at which level you wish to complete at this stage.
Section Six: Additional Information
Highest Academic Qualification to date:
Please state your professional background, reasons you would like to attend the course and your expectations:
Where did you hear about the National PSHE CPD Programme?
Do you have any dietary requirements?
Section Seven: To be completed by the Applicant’s Line Manager
Please indicate / The employer/line manager: 
 supports this application
 confirms the applicant has the capacity to complete the course and achieve the qualification at the level indicated
 agrees to provide opportunities for the applicant to complete the course requirements. / Employer/line manager name:
Employer/line manager telephone number:
Employer/line manager email address:
Applicant: / Date: / Signature:
Line Manager: / Date: / Signature:
Section Eight: Funding arrangements
Funding arrangements / Payment for Babcock 4S programme will be required as follows:
Course fees of £795.00 (plusVAT) will be requiredonce the participant has been approved onto the PSHE Training Programme.
Withdrawal from the programme must be confirmed 7 working days in writing, prior to the start date, otherwise a 50% cancellation fee will be incurred.
Please indicate below by marking the related box with an X, who will be funding the cost of this programme.
Self-funded
Payment required in advance. Please complete section 8a for payment by card or cheque(payment will be taken only following booking confirmation)
School
 Employer
Local Authority
All above, except self- funded, will be invoiced. Please complete section 8bbelow.
Section 8a
Self-funded payment options below:
Cheque
Please make a cheque payable to Babcock 4S Ltd
If paying by cheque, please include with the applicationform. (Cheques will only be
processed if the application has been approved)
Card payments
Call Finance Shared Service Centre on 02392 316262ONLY when application has been
approved.
Section 8b
Billing details
Establishment Name: …………………………………………………………………………….
Billing Address: ……………………………………………………………………………………
……………………………………………………………………………………………………….
………………………………………………………………..Post Code:………………………..
Finance Contact No: ………………………. Email: ……………………………………………
Purchase Order Number: …………………………………………………………………………
Approved by: Name Printed………………………. Signed: …………………………………
Position: …………………………………………….Date: ……………………………………….

Revision 13 Date: 13/06/2015