CYM Degree Programme Application form

CYM Degree Programme Application Form 2020

This form is for anyone wishing to study for a degree with CYM

Step 1 of 8

Please complete the form below indicating which course you are applying for.
Personal details
Title First Last
Telephone number*
Email*
Street Address Address Line 2 City County / Region Post Code Country
Contact Address (if different to above)
Street Address Address Line 2 City County / Region Post Code Country
Country of birth*
Country
Nationality*
Date of birth*
Date Format: DD slash MM slash YYYY
Number of years of Residency (if not born in UK/EU)
Please enter the number of days sick taken in the last year*

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Equality and Diversity
Some of the following questions are optional but will support our Equality and Diversity recording.
Ability Status*
Ethnic Group
Gender*
Employment Status
Special educational needs*

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Course details
I am applying for:*
I would like to study at:*
Start Date
How did you find out about CYM and the course?
We are interested to know how you found out about CYM and our great courses, so thank you for letting us know how it worked for you.
Which events/conferences/ exhibitions do you attend?
- National Youth Ministry
- Hand in Hand
- Joined Up
- Soul Survivor
- New Wine
- Spring Harvest
- Greenbelt
- CRE
- Other

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Please provide a personal statement outlining why you want to do this course*
Employment history and voluntary work experience
Please give full details of work experience with young people, children, families and /or schools*
Date started (mm/yy) Employer Position Nature of work Date completed (mm/yy)
Experience details*
Please give full details of work you have undertaken with young people, communities, children, families and/or schools, especially the church(es) and/or agency(ies) you have been working with, nature of the work, time spent in the various types of work and how long you were doing that particular work. Please illustrate how you have fulfilled the 'professional' entry criteria

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Education and qualifications
Give details of educational institutions attended (secondary schools, colleges, universities)*
Institution Full or Part Time From (mm/yy) To (mm/yy)
Give details of qualifications that are completed or certificated (examinations or assessments for which results are known, including those failed)
Date of results (mm/yy) Awarding body Subject/unit/module Level Result/grade
Give details of qualifications that are not yet completed or results not yet published
Date results due (mm/yy) Awarding body Subject/unit/module Level
Other interests and further information*
Please use this section to tell us briefly about yourself and your reasons for wanting to study the course

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Do you have a Potential Professional Practice Agency (PPA) in mind? Please return the Potential Professional Practice form)
You answered no, what type of PPA are you looking for?
If you are undertaking the JNC endorsed route, please provide the name and details of the placement

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Personal declaration
Because of the nature of the course for which you are applying, this application is exempt from the provisions of Section 4(2) of the Rehabilitation of Offenders Act 1974 by virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975. This means you are therefore not entitled to withhold information about convictions which for other purposes are “spent” under the provisions of the Act. In the event of acceptance, failure to disclose such convictions could lead to disciplinary action being taken and any offers for a place on the course being withdrawn. Any information given will be treated in the strictest confidence and used solely in relation to this application. Please be aware that for positions involving substantial access to young people or children a system of checking police records for possible criminal background will be implemented.
Have you ever been convicted or cautioned with respect to a criminal offence?*
- Yes
- No
Please give full details of your criminal conviction or caution
I confirm that all information given in this application is true, complete and accurate and that no information requested or other material information has been omitted. I agree to my personal data being processed by my chosen partner college and where appropriate by CYM and Staffordshire University.*
- I DO
PLEASE TYPE YOUR NAME HERE THIS WILL BE YOUR SIGNATURE OF AUTHORISATION ON THIS DIGITAL FORM*
This is your signature for this digital document.
Date*
Date Format: DD slash MM slash YYYY
GDPR
From the time you first contact CYM, we hold appropriate personal information on file both in paper format and electronically. Under GDPR we need your consent to use your information in ways appropriate to the efficient conduct of our business. By submitting this form I give my consent to CYM holding my personal data relating to my studies.
GDPR Consents
- I give my consent to the sharing of this information to appropriate third parties including any sponsors or validating bodies
- I give my consent to be contacted with information about other courses and news about the activities of the College
- I understand that I have the right to access my data, ensure it is correct and have my data erased

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References
Please provide the details of the three referees to whom you will be sending your forms. One should be from your current or most recent employer, one from someone who knows your work with children, schools or youth work, and the third should be a personal reference, normally from a Church Leader where appropriate. You cannot submit references from family members.
Employer/College/School
Name
Organisation
Relationship to candidate
Children/School/Youth/Communities work
Name
Organisation
Relationship to candidate
Personal reference
Name
Organisation
Relationship to candidate

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Date started (mm/yy)	Employer	Position	Nature of work	Date completed (mm/yy)

Institution	Full or Part Time	From (mm/yy)	To (mm/yy)

Date of results (mm/yy)	Awarding body	Subject/unit/module	Level	Result/grade

Date results due (mm/yy)	Awarding body	Subject/unit/module	Level

CYM Degree Programme Application form

CYM Degree Programme Application Form 2020

Step 1 of 8

Please complete the form below indicating which course you are applying for.

Personal details

Equality and Diversity

Course details

Employment history and voluntary work experience

Education and qualifications

Personal declaration

GDPR

References

Employer/College/School

Children/School/Youth/Communities work

Personal reference