appform

							  Hampshire Learning Module Application

Please complete the form in BLOCK CAPITALS using black ink and email or send it to:
Gene Burgoyne, 31 Kingsway, Aldershot, Hampshire, GU11 3PF – email trainingadmin@scouts-hants.org.uk .
Applications must be received at least three weeks before the course date. Applications after this date may not be
accepted.
Title:        First name(s) (underline name you wish to be known by)        Surname


Computer no. (on Appointment Card)              Date of birth                       Previous name


Scout appointment                               District                            County


Group                                                            Occupation


Dietary Requirement / Special Needs                              Religion / Faith



Address                                                          Home phone no.



                                                                 Mobile phone no.



                                                                 Fax no.


Postcode                                        e-mail address




Modules applied for:                            Date/Method                                                Date/Method
3 Tools for the Job (Section) (M E)                              20 Administration (Manager) (M)
4 Tools for the Job (Managers) (M E)                             21 Growing the Movement (Manager)
5 Fundamental values (M E)                                       22 Section support (M)
6 Changes in Scouting (M)                                        23 Safety for managers (M)
7 Valuing diversity (M)                                          24 Managing adults (M W)
8 Skills of Leadership (M)                                       25 Assessing learning (M)
9 Working with adults (M)                                                 Circle Learning Choice: TA / Mgr / NAA / AA / SSA
11 Administration (Section) (M)                                  26 Supporting adults (M W)
12 Balance programme (M E)                                       30 Supporting local learning (M)
13 Growing the Movement (M W)                                    35 Internal moderation (M)
14 Young people today (M W)                                      36 Special needs (M)
15 Challenging behaviour (M W)                                   37 Advising on Adult Appointments (M)
16 Intro to Residential Experiences (M)                          38 Skills for Residential Experiences         Use M38 Form
17 Activities outdoors (M)
18 Practical skills (M)
19 International (M)
Notes:                                                           H1 Ticking all the boxes Workshop
Methods: M – Module / E - e-Learning / W – Workbook
                                                                 H2 Safeguarding Workshop                  Use SG Form
Module 25: Indicate learning version required.

Modules 27 - 29 and 31 - 34: Portfolio of evidence required, register with DCTM (Trainer Assessment)

Signed:                                                          Training admin use
                                                                 Received:

  A cancellation charge will be levied if you do not attend and do not advise the Course Director a minimum of
  two days before the course (five days for M38 Skills for Residential Experiences module).
                                                                                                                 Appform 03/11