Agency Application form

Address
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Agency Application Form
For delivery and assessment of accredited CYM FE courses at Level 2/Level 3)
Agency Name
Name of Key Contact within Agency
First Last
Phone
Email
Website
Is address for Post different from Key Contact
- No
- Yes
Address for Post
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Training Venue Address
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Using CYM FE courses
How do you think you might like to use a CYM FE course within your organisation?
What benefits are you looking for?
Health and Safety Policy for training venue
Accepted file types: pdf, txt, doc, docx, rtf, jpg.
Name(s) of tutor orassessors (all tutor or assessors must complete a tutor or assessor application form)
First Name Last Name Email Address
Agency Declaration
All information given on this form is accurate to the best of our knowledge. As a CYM HUB agency will notify CYM of any change to these details within 1 month of the change.
We would like to run:
- Explore youth work – Level 2
- Equip for youth work – Level 3
- Engage Children’s Ministry – Level 3
- Enable Schoolswork – Level 3
Please type your name below this will be your signature of authorisation for this form, you have signed on behalf of the agency as a representative.
First Last
Your position relative to agency.
Date
Date Format: DD slash MM slash YYYY

First Name	Last Name	Email Address

Agency Application Form