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Adult Social Care Grant - Application Form
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HOW TO BOOK:
Identify the course(s) of interest to you, and discuss with your manager. Photocopy the form in this brochure and complete it with your manager. Return the form(s) as soon as possible to:
Adult Social Care Grant Administration, SCA Ltd Suite H4, Leatherhead Enterprise Centre, Randalls Way, Leatherhead, Surrey, KT22 7RY
Tel: 01372 825116 Fax: 01372 825125
Bookings will only be accepted on receiving completed, signed application forms and a signed declaration. Applicants who are successful in gaining a place will receive a confirmation email or fax with course details within 14 days. Those who are not successful will be placed on a waiting list and contacted accordingly. You must receive an email or fax confirmation before attending a course and bring your confirmation letter along with you on the day. Please note that anyone who has not been confirmed as a delegate will not be allowed to attend. If you are in doubt of whether you have secured a booking please call Lisa or Lynn on one of the telephone numbers given below. We reserve the right to cancel a given course in the event of low take up. If you have any queries please contact ASCG Administration, Lisa Mack 07779 584397 or Lynn O’Byrne 07973 458208 or email training@surreycare.org.uk
CHECK LIST: Please remember to return Signed completed application form Signed declaration & Other Information Form Please return all completed forms to:
Adult Social Care Grant Administration, SCA Ltd Suite H4, Leatherhead Enterprise Centre, Randalls Way, Leatherhead, Surrey, KT22 7RY
1
Office use only.
Adult Social Care Grant 2009-10 Course Application Form
To be photocopied and completed by each applicant/manager. Please use block capitals. Surname Job Title Home Address Town Daytime Phone No Do you have any special requirements? Line manager’s name Organisation name Organisation address Town Phone No. Email (Business) County Fax County Postcode First Name Title
Rec’d Conf
Query Comm
Y/N
Postcode
(An email address and/or fax number MUST BE PROVIDED to ensure confirmation of applicants place) PLEASE ENSURE THE EMAIL ADDRESS THAT YOU INCLUDE HERE IS CHECKED REGULARLY
Name of course
1 2 3 4
Date
Office Use only
All
W/L
Places will initially be restricted to two courses per candidate. Please include details of your course details in order of preference.
To be signed by the applicant I wish to be allocated a place on the above course(s) and upon confirmation I agree to attend the course and complete any necessary feedback and post course evaluation Name Please print name Signed To be signed by the applicant’s line manager: I agree to release the applicant for training on the above courses and to complete any necessary post-course evaluation Name Please print name Signed
RETURN COMPLETED FORM TO: Adult Social Care Grant Administration, SCA Ltd
Date
Date
2
Suite H4, Leatherhead Enterprise Centre, Randalls Way, Leatherhead, Surrey, KT22 7RY
Declaration:
Name Please print name
In applying for training supported by the Adult Social Care Grant
I understand that this training contributes towards individuals in my organisation achieving qualifications defined in the National Minimum Care Standards I agree to provide any information and evidence about the training attended to satisfy audit requirements I am not accessing both Adult Social Care grant funding and Skills for Care TSI unit funding to support the same individual on the same unit or training activity (ie double funding) I am not funding the named applicants for this training with Adult Social Care grant accessed from another Local Authority I understand places will be allocated subject to the eligibility criteria for the Adult Social Care grant I understand that, in the event of applicants failing to take up their confirmed places, Surrey Care Association Ltd reserve the right to invoice you (the company) £50 per course. However the fee will be waived if an eligible substitute can attend and ASCG administration is informed of the change 2 weeks in advance of the courses.
Signed …………………………………………………….. Date ……………………………….. SCA Ltd may wish to contact you from time to time about courses or learning opportunities relevant to you. Please tick the box if you do not wish to be contacted.
Other Information:
Is the course applicant working towards an NVQ Award or Certificate, or management qualification? NVQ Level 2 Health and Social Care NVQ Level 3 Health and Social Care NVQ Level 4 Health and Social Care NVQ Level 4 in Management Registered Managers Award Other (please specify) Is this being supported by any of the funding streams? Skills for Care Training Strategy Implementation (TSI) grant European Social Fund (ESF)/Learning and Skills Council (LSC) Other (please specify) Relevant qualifications already held Did you attend an Adult Social Care Grant (Formerly NTSG) Course in the 2008-09 Programme ? No Yes If so, how many courses
RETURN COMPLETED FORM TO: Adult Social Care Grant Administration, SCA Ltd
Suite H4, Leatherhead Enterprise Centre, Randalls Way, Leatherhead, Surrey, KT22 7RY
3
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