Application for Funding � by 5N343H

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									                      Yorkshire and The Humber Pharmacy
                      Technical & Support Staff Development Unit



                              Application for Backfill Funding –
               Foundation Degree in Medicines Management & Pharmacy Services

                                                Guidance Notes
1.      Funding for Course Fees may be obtained from your Trust/PCT Education & Training Department.
           The SHA have provided funding via the Support Staff Learning & Development Fund.

2.      This form should be used to apply for funding for Backfill only for the full Foundation Degree in
            Medicines Management and Pharmacy Services (Fd) programme at the University of
            Huddersfield.

Process for application
2.1. Approval must be sought from a line manager.
2.2. Application form for University of Huddersfield must be completed and sent to University of Huddersfield.
2.3. Application for backfill must be completed and sent to YPTSSDU before 10th July 2009.
2.4. A personal statement should be submitted (approx 250 words) with Backfill Application, stating how the
Foundation Degree will support role development.

3.      Applications will be processed on a first-come, first-served basis and waiting lists will be held.

4.      The following criteria for backfill funding apply:

         Criteria:                                                       Evidence:                      Essential/
                                                                                                        Desirable
         All applicants must submit a personal statement (max            Personal statement              Essential
         250 words) detailing how the FdSc will aid their role           Funding application form.
         development.
         Work for the NHS/provide services for the NHS.                  Course application form.        Essential
         Possess NVQ3/equiv Royal Pharmaceutical Society of              Course application form.        Essential
         Great Britain registerable qualification.
         Job Description/Person Specification to include Fd as a         Copy of Job Description.        Desirable
         desirable component.
         Have support from their line manager to attend.                 Employer letter.                Essential
         Be able to identify a ‘mentor’.                                 Course application form.        Essential
         Workplace commitment to support independent study               Funding application form.       Essential
         time.
         Workplace release to attend all taught sessions (NB             University certificate(s) of    Essential
         because of low attendance requirement at University, it is      attendance.
         expected that trainees attend all sessions)                     Study leave profile.

5.      As the number of taught sessions at the University is minimal, it is expected that students attend all
        sessions. Failure to attend without a valid reason and approval of academic supervisor may result in
        funding being withheld/reclaimed.


6.      Monitoring progress. All organisations receiving funding allocation will be required to submit progress
        summaries periodically. The YPTSSDU will manage this monitoring process, and provide returns to
        the Yorkshire and the Humber SHA where required.




GR 0608
                           Yorkshire and The Humber Pharmacy
                           Technical & Support Staff Development Unit



                                           Funding Application Form

   Name of Candidate:
   National Insurance Number:
   Date of Birth:
   (necessary to allocate funding):
   Job Title/Role:
   Employer:
   Workplace Address:
   (inc. postcode)



   Workplace Telephone No.:
   Workplace Email :
   (if available)
   Home Address:
   (inc. postcode)



   Home Telephone No.:


   Planned Start Date:


   Previous Qualifications and Grades (necessary to allocate funding):
   Please continue overleaf if required.
   Qualification and Level (highest qualification first):                                     Grade




    For Office Use Only:
    Date Application Received:   ______________           Funding Allocated: Yes / No
    Funding Stream (please specify):____________________________________________________________
    Notes:




** As the number of taught sessions at the University is minimal, it is expected that students attend all sessions. Failure
   to attend without a valid reason and approval of academic supervisor may result in funding being withheld/
   reclaimed.
                        Yorkshire and The Humber Pharmacy
                        Technical & Support Staff Development Unit




PERSONAL STATEMENT (max 250 words; continue on a separate sheet if required)
   Please state below how the Fd will aid your role development.




6.       DECLARATION

I confirm the information provided above, and in any attachments, is correct and understand that any false
statement could result in funding being withheld or reclaimed.

Signed (applicant):                                                              Date:


FOR OFFICE USE ONLY. WAS THIS APPLICATION FOR FUNDING SUCCESSFUL? YES/NO.
IF NO, PLEASE STATE REASONS BELOW:




** As the number of taught sessions at the University is minimal, it is expected that students attend all sessions. Failure
   to attend without a valid reason and approval of academic supervisor may result in funding being withheld/
   reclaimed.
                    Yorkshire and The Humber Pharmacy
                    Technical & Support Staff Development Unit



                         EQUAL OPPORTUNITIES MONITORING FORM

The data collected here will be processed in accordance with the Data Protection Act 1998 and
used for monitoring purposes only.
Please delete/tick where necessary:

GENDER                                                           Male/Female
HOURS OF WORK                                                    Full time/Part time
DO YOU CONSIDER YOURSELF TO BE DISABLED?                         Yes/No
HIGHEST QUALIFICATION:
          NVQ Level 1                                            
          O-LEVEL / GCSE / NVQ Level 2 or equivalent             
          A-LEVEL / NVQ Level 3 or equivalent                    
          Degree / NVQ level 4                                   
          Other                                                  
          None                                                   
ETHNIC ORIGIN:
          White, British                                         
          White, Irish                                           
          Any other white background                             
          Mixed – White and Black Caribbean                      
          Mixed – White and Black African                        
          Mixed – White and Black Asian                          
          Any other mixed background                             
          Asian or Asian British – Indian                        
          Asian or Asian British – Pakistani                     
          Asian or Asian British – Bangladeshi                   
          Any other Asian background                             
          Black or Black British – Caribbean                     
          Black or Black British – African                       
          Any other black background                             
          Chinese                                                
          Other ethnic group                                     
          Not stated/prefer not to say                           

								
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