Office use only
P CV AA reply I T CRB
APPLICATION FORM - STUDENT ASSOCIATES SCHEME 2008/9
Surname: First Name:
Address (term time) Address for cheque to be sent to if different from term
Current University: Department:
Course title of study: Year of Study:
Please indicate whether you prefer a Secondary or Primary school for your placement, and also your subject
area. Preference will be given to students opting for Priority 1 subjects. Mark in order of preference 1st, 2nd, 3rd.
SECONDARY SUBJECTS PRIMARY
Priority 1 Priority 2 Priority 3 Foundation
Mathematics Science Business Studies Key Stage 1
Physics I.C.T P.E Key Stage 2
Chemistry D&T English Primary places are very
MFL Other (please state below) limited and priority will be
RE given to students whose
subject strengths relate to
Music maths, science or MFL
PERSONAL DETAILS (please print)
number(s) Mobile: email address:
Date of Birth: Age: Mr Mrs Miss Ms
Student Registration Number: National Insurance Number:
Are you Registered Disabled? Yes/No Have you previously trained as a teacher?
Registration No: Yes/No
Have you taken part in the Student Associate Do you have a full current driving licence and the
Scheme previously? Yes/No use of a car? Yes/No
Do You have a CRB (Enhanced Certificate) to work with children/young people? Yes/No
Registration No: Issuing Authority: Date on Certificate:
EDUCATION AND QUALIFICATIONS
Grade Date Equivalent Qualification (if not in UK) Grade Date
GCSE English English
GCSE Maths Maths
GCSE Science Science
In awarding places on the scheme applicants’ qualifications are taken into account.
The basic requirement for a secondary ITE course is Grade C in English and mathematics.
The basic requirement for a primary ITE course is Grade C in English, mathematics and science.
EDUCATION AND QUALIFICATIONS - Further Qualifications
Subjects Qualification (A level, NVQ, etc) Grade Date awarded
Please complete the table below with details of any relevant experience of working with children and
young people and/or using your subject knowledge in previous employment, which would support your
application for a place on the scheme.
Paid or Full Time or
Date Post or Activity voluntary Part Time Length of time
If you prefer not to complete this section please tick this box
Information to be used for statistical purposes only
The University of Wolverhampton is committed to equal opportunities. We aim to eliminate
unfair discrimination against anyone in our recruitment and selection procedures. We
encourage applications from groups presently under-represented in the teaching profession.
I understand that Student Associates are required to make a ‘Fitness to Teach’ declaration and apply to
the Criminal Records Bureau for an enhanced certificate.
I confirm that the information provided on this application form is correct.
(an email signature is acceptable)
Please return your completed application form and a CV to:
Mike Spragg, Student Associates Scheme Manager, University of Wolverhampton,
School of Education, Walsall Campus,Gorway Road, Walsall WS1 3BD. (email: email@example.com)