SCITT PGCE & QTS Application Form | Teacher Training in Essex

Year in which you wish to train

Courses for which you wish to apply (tick as many boxes as apply to you)

Phase*

Course Type*

Salaried
Fee paying
Full-time
Part-time

Additional Specialisms

Special Needs
Maths
Behaviour

Preferred Training Base

Southend-on-Sea*

Southend-on-Sea

Course TypeWickford*

Wickford

Applicant Details

Pronoun (PLEASE TICK APPROPRIATE BOX)

He/Him
She/Her
They/Their

Surname / Family name (BLOCK CAPITALS)*

First name (s)*

Previous surname / Family name, if changed*

Address*

Telephone number*

Email Address*

Date of birth*

Do you have any criminal convictions or are you currently on bail or being investigated by the police?*

Yes
No

Nationality*

Country of birth*

Country of birth

Country of permanent residence*

Do you need a visa to live in the UK?*

Yes
No

If yes, please provide your passport number

Passport Number*

For applicants not born in the UK

Date of first entry to the UK

Date of most recent entry to the UK (excluding holidays)

Have you been granted Indefinite Leave to Enter/Remain in UK

Yes
No

If you are a non-British EU National who is not living in the UK, will you have been resident in the EU for 3 years prior to the 1st of September of the year in which the AO period begins?

Yes
No

Do you have any special needs including dyslexia or medical condition?*

Yes
No

Do you have any criminal convictions or are you currently on bail or being investigated by The Police?*

Yes
No

Failure to disclose criminal convictions may lead to offers of assessment being withdrawn.
It is not possible to accept applicants who have previously failed a QTS assessment or withdrawn from a QTS programme unless there are exceptional circumstances. If this applies to you, please provide a written explanation and also provide the contact details of your previous training provider.

Please give details of any additional needs including dyslexia and/or any medical conditions?

Previous QTS Assessment

Have you failed or withdrawn from a QTS course?*

Yes
No

If yes, give the name of the previous course and provider
If yes, please give details of circumstances

Course and Provider Name*

Circumstances Details*

Qualifications

Degrees or equivalent

Name of Institution*

Class*

Title of course*

From*

To*

GCSEs or equivalent qualifications

Subject

Grade

Awarding Body

Date of award

Pending

Subject

Grade

Awarding Body

Date of award

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Grade

Awarding Body

Date of award

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Awarding Body

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Awarding Body

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Awarding Body

Date of award

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Awarding Body

Date of award

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Awarding Body

Date of award

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Awarding Body

Date of award

Pending

Pending

Subject

Grade

Awarding Body

Date of award

Pending

Pending

Skills Tests
Please let us know if you have already passed your skills tests

Subject*

Date passed*

Subject*

Date passed*

Please give details of previous employment. Please start with your current employment.

Employment

Please add rows as necessary

From

To

Name of employing institution

Street Address

Town

Postcode

Role

From

To

Name of employing institution

Street Address

Town

Postcode

Role

From

To

Name of employing institution

Street Address

Town

Postcode

Role

From

To

Name of employing institution

Street Address

Town

Postcode

Role

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Name of employing institution

Street Address

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To

Name of employing institution

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Name of employing institution

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To

Name of employing institution

Street Address

Town

Postcode

Role

From

To

Name of employing institution

Street Address

Town

Postcode

Role

From

To

Name of employing institution

Street Address

Town

Postcode

Role

Personal Statement

Please describe your reasons for wanting to become a primary school teacher. You should make reference toyour personal strengths, qualities, skills and previous experience working with children.*

Reasons*

Data Protection Act, 1998: The information that you have supplied will be processed and held on computer. The data may be processed for the purpose of compiling statistics, and passed to the Higher Education Statistical Agency and the Higher Education Funding Council for England. By signing and returning this application form you will be deemed to be giving your consent to the processing of data contained within it and the use of that data for the lawful purposes approved for the institutions to which it is supplied.

Referee Details

Name of referee

Relationship / Role

Address

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Email

Telephone

Name of referee

Relationship / Role

Address

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Email

Telephone

Ideally one reference should be from a professional who has observed you working with children.

Declaration

Declaration*

I confirm that the information I have given on this form is true, complete and accurate and no information requested, or other material information, has been omitted.
I agree that the information in this application may be stored on a secure SCITT database I do not already have Qualified Teacher Status.

Signature*

Date*

'Putting Pupils First, Training Excellent Teachers'

'Putting Pupils First, Training Excellent Teachers'

SCITT PGCE & QTS Only Application Form

Primary & Secondary

Courses for which you wish to apply (tick as many boxes as apply to you)

Preferred Training Base

Applicant Details

Previous QTS Assessment

Qualifications

Employment

Personal Statement

Referee Details

Declaration