Forename. Middle name Last name E-Mail Previous name Surname at birth Address Line1 Address Line 2 Address Line 3 City Country Postcode Phone number Home number Mobile number Personal Details Date of birth NI Number Gender Ethnicity Nationality National Identity National Identity 2 Domicile Disability (Please describe) Disabled student allowance Service Leaver: Yes/No Entry Qualification details Maths GCSE grade English GCSE grade Science GCSE grade A-levels/equivalent Subject/grade and when achieved Placements School1 Duration Address School phone number Finance e-mail Name of Head Teacher Name of school CPD co- ordinator/Professional Tutor What position do you currently hold? Full time/ Part time If part time percentage of time working as a teacher Is the school a State primary Academy International State secondary Free School COBIS Special school Independent Other Age range of pupils taught Subjects taught School experience of QTS assessment Has the school previously worked with St Mary’s? Is the school part of the St Mary’s school partnership? Has the school had experience of QTS candidates through another provider? Mentor experience of ITE Please give details of mentor’s experience Has the mentor undertaken any mentor training? If yes through which institution School 2 Placement 2 duration Address Position held Full time/ Part time If part time percentage of time working as a teacher Is the school a State primary Academy International State secondary Free School COBIS Special school Independent Other Age range of pupils taught Subjects taught Course Phase ITT subject 1 ITT subject 2 ITT subject 3 Entry Details Additional Academic Qualifications First degree or equivalent: BA, BSc, other Subject of UG degree Class of UG degree Awarding Institution Date undergrad degree obtained Date skills tests passed English Math DBS Certificate number Applicant statement I confirm that all of the information I have provided is accurate I confirm I can provide original certificates at the interview stage of my application I understand that the information on this application will be stored on a database and made available to the Department for Education Signature Date Partnership Agreement confirmation between St Mary’s University and (insert name of school)
Forename. Frati Function of the Legal Representative: Xxxxxx Mr/Mrs/Ms [Student name and forename] Date of birth: Nationality: Address: [official address in full] Phone: E-mail: Gender: [Male/Female/Undefined] Academic year: 20../20.. Study cycle: [First cycle/Second cycle/Third cycle/Short cycle/One-cycle study programme] Subject area: [degree in sending institution] Code: [ISCED-F code] Number of completed higher education study years: Student with: ☐ a financial support from Erasmus+ EU funds ☐ a zero-grant ☐ a financial support from Erasmus+ EU funds combined with zero-grant The financial support includes: ☐ special needs support ☐ financial support to student with disadvantaged background Details of the Bank account or card must be uploaded in the Segreteria on-line. Called hereafter “the participant”, of the other part, Have agreed to the Special Conditions and Annexes below which form an integral part of this agreement ("the agreement"): [Key Action 1 – HIGHER EDUCATION] Annex I [Learning Agreement for Erasmus+ mobility for studies/ Learning Agreement for Erasmus+ mobility for traineeships/Learning Agreement for Erasmus+ mobility for studies and for traineeships] Annex II General Conditions Annex III Erasmus Student Charter The terms set out in the Special Conditions shall take precedence over those set out in the annexes. [It is not compulsory to circulate papers with original signatures for Annex I of this document: scanned copies of signatures and electronic signatures may be accepted, depending on the national legislation or institutional regulations.] SPECIAL CONDITIONS
Forename. Age : .................................. Sex : ................................ Nationality : ................................................................. Home institution : .................................................................................................................................................... Staff position/student year of study at home institution: .......................................................................................... Host institution(s) : ..................................................................................................................................................
Forename. Title Forename Middle name(s) (Required) Surname Middle name(s) (Required) Surname Maiden name/Previous name (Required) Retirement age Date of birth Maiden name/Previous name (Required) Retirement age Date of birth Nationality How long have you lived in the UK? Current country of residence Are you a UK resident? Permanent right to reside in UK? Yes No Yes No Nationality How long have you lived in the UK? Current country of residence Are you a UK resident? Permanent right to reside in UK? Yes No Yes No Have you ever had a Default or County Court Judgement registered against you? Please provide full details in section 12. Have you ever failed to keep up with payments on a mortgage, loan, credit card etc.? Please provide full details in section 12. Yes No Yes No Have you ever had a Default or County Court Judgement registered against you? Please provide full details in section 12. Have you ever failed to keep up with payments on a mortgage, loan, credit card etc.? Please provide full details in section 12. Yes No Yes No Total no. of adult dependants Total no. of child dependants Ages Ages Total no. of adult dependants Total no. of child dependants Ages Ages 2 Current address details For expat borrowers, please detail last UK addresses held. First Applicant Second Applicant Current address Current address Postcode Time at current address Years Months Postcode Time at current address Years Months Occupancy type - i.e. homeowner, renting etc. Occupancy type - i.e. homeowner, renting etc. 3 Previous address details First Applicant Second Applicant Previous address - If less than 3 years, please provide a full 3 years’ history Postcode Time at current address Years Months Previous address - If less than 3 years, please provide a full 3 years’ history Postcode Time at current address Years Months
Forename. Year/Registration Group: Relationship to Student: MEDICAL/HEALTH INFORMATION: □ No □ Yes (if yes, please state below or if possible provide medical documents and details of current medication. This will ensure the school is aware of the requirements for the student) Details:
Forename. Surname; email address*; Username Academic staff
Forename. Surname; email address*; Username
Forename. Surname ........................................................................... Position ...................................................................................................................................................................................... Department ............................................................................................................................................................................... Fax....................................................................................... Telephone .............................................................................. Email…………………………………………….............................................................................................................................................
Forename. DOB Address Contact Number Band and date band awarded Stat Homeless Current /Former tenant arrears Medical needs yes/no Any further information Date of offer Successful or unsuccessful? Reason for decision (using reason codes provided) Date of refusal or acceptance APPENDIX 3 - REASONS CODES CODE DESCRIPTION ACCEPT Property was accepted by the applicant(s). AREA Applicant(s) is not interested in the area. ARREARS Applicant(s) has rent arrears. GROUND Applicant(s) requires a ground floor property. HIGH Property has been offered to a higher placed applicant(s). LIKE Applicant(s) does not like the property. MED Property unsuitable due to the applicant’s disability. MOVED Applicant(s) is no longer at this address or contact telephone number was unobtainable. XXXXX XX unable to contact the applicant(s) or applicant(s) did not contact the RP. NOINT Applicant(s) did not attend the interview arranged. NOLON Applicant(s) no longer requires re-housing. NOREF Applicant(s) was unable to provide references. NOTRE Applicant(s) is not ready to move. PET Applicant has a pet(s). Pets are generally not allowed at the property. RENT Rent is too expensive for the applicant(s). SIZE Property unsuitable due to size. XXXXX Applicant(s) do not want sheltered accommodation. TYPE Property unsuitable due to type. UNSAT Unsatisfactory references received. APPENDIX 4 - NOMINATION MONITORING FORM 17 APPENDIX 5 – EQUALITY ANALYSIS EQUALITY ANALYSIS FORM THE FOLLOWING QUESTIONS WILL DOCUMENT THE EFFECT OF YOUR SERVICE OR PROPOSED POLICY, PROCEDURE, WORKING PRACTICE, STRATEGY OR DECISION (HEREAFTER REFERRED TO AS ‘POLICY’) ON EQUALITY, AND DEMONSTRATE THAT YOU HAVE PAID DUE REGARD TO THE PUBLIC SECTOR EQUALITY DUTY.
Forename. I have read and understand the contents of the Sixth Form Agreement. I undertake to continue to comply with the obligations contained therein that accompany joining the Sixth Form at Xxxxxx Endowed School. Signed (Pupil): Date:
