This is the application form for the National Skills Academy/SkillsActive Yorkshire and Humber Coaching Bursary which is being co-financed by the Learning and Skills Council and Sport England in the region. Please note that due to high levels of demand, we are only taking applications for current UKCC endorsed courses.  A reference will be required as part of this application process and you must be registered on a UKCC coaching course to qualify for funding. If you have any questions about the scheme, please do not hesitate to contact somebody from your County Sports Partnership, Regional Governing Body or alternatively Simon Lewis - Coaching Bursary Administrator at simon.lewis@sportactivensa.co.uk. Good Luck!

Terms and Conditions

Please read the following section carefully and identify whether you agree to the terms of the application below.

Please be aware that successful applicants will be required to pay for their qualification in full up front.  If your application is successful, you will be presented with a 'Bursary Voucher' which can only be redeemed once you have completed your course and after the required hours of coaching have been delivered and registered on your activepassport.

	I meet the eligibility criteria for this programme, as set out on the coaching bursary website	Agree	Do not Agree

	I will undertake the the required procedures to recieve a reimbursement of 60% of the course fees	Agree	Do not Agree

Even if you are not eligible for this programme, the National Skills Academy can keep you informed about new qualifications and schemes that may be of interest to you

	Please tick here if you do not wish the National Skills Academy to contact you regarding the latest National Governing Body Technical Qualification courses in the future.

Your Personal Details

	Please complete your details below:
	Title:
	First name:
	Surname:
	Address 1:
	Address 2:
	Town:
	County:
	Postcode:
	Telephone number:
	Mobile number:
	Personal email:

Your Personal Details

	Gender: Please select one only
	Male
	Female

Age

	Ethnic background: Please select one only
	White
	Asian/Asian British
	Mixed ethnic background
	Black/Black British
	Chinese
	Other ethnic background (please specify below)
	Would prefer not to say

Your Personal Details

	Do you consider yourself to have a disability / impairment? Please select one only
	Yes
	No
	Don't know
	Would prefer not to say

	Please specify which category of disability that you have
	Visual impairment
	Hearing impairment
	Disability affecting mobility
	Other physical disability (please specify below)
	Other (please specify below)
	Prefer not to say

Your Bursary Application

Please provide the following details about the course that you are currently booked on and the coaching that you are currently undertaking or plan to undertake upon completion of the course

Which sport is the course associated with? Please select one only
Angling		Football		Rugby Football League
Archery		Golf		Rugby Football Union
Athletics		Gymnastics		Squash
Badminton		Hockey		Swimming
Basketball		Judo		Table Tennis
Canoeing		Netball		Tennis
Cricket		Orienteering		Triathlon
Cycling		Rounders		Volleyball
Equestrian		Rowing

Which level of qualification would you like to achieve in this sport? Please select one only

	Angling
	Level 1
	Level 2

	Archery
	Level 1

	Athletics
	Level 1
	Level 2

	Badminton
	Level 2

	Basketball
	Level 1
	Level 2

	Canoeing
	Level 1
	Level 2

	Cricket
	Level 1
	Level 2

	Cycling
	Level 2

	Equestrian
	Level 2

	Football
	Level 1

	Golf
	Level 1
	Level 2

	Gymnastics
	Level 1
	Level 2

	Hockey
	Level 2

	Judo
	Level 1
	Level 2

	Netball
	Level 1
	Level 2

	Orienteering
	Level 1
	Level 2

	Rounders
	Level 1
	Level 2

	Rowing
	Level 2

	Rugby League
	Level 1
	Level 2

	Rugby Union
	Level 1
	Level 2

	Squash
	Level 1
	Level 2

	Swimming
	Level 1
	Level 2

	Table Tennis
	Level 1
	Level 2

	Tennis
	Level 1
	Level 2

	Triathlon
	Level 1
	Level 2

	Volleyball
	Level 1

Please note that if the level you wish to select is not available for your chosen sport, it will either be because that particular level is currently not eligible for a bursary, or it will be because all bursaries have already been allocated for that level.  For further information please contact the bursary administrator

Do you currently hold the relevant entry level qualifications to undertake this qualification?

Yes

No

Please note you MUST have the correct entry requirements to undertake level 2 and level 3 qualifications i.e. with the exception of rowing you MUST have a level 1 qualification in the sport to undertake a level 2 qualification and a level 2 qualification to undertake a level 3 qualification.

Please provide the details of the course you are registered to attend:

	Start date (DD/MM/YYYY)
	Venue

Your Current Coaching Activity

	Are you currently active as a coach Please select one only
	Yes
	No

	If no, how do you intend to use your new coaching qualification? Please select one only
	Plan to start coaching with affiliated club - once qualified
	Plan to set up my own club/sporting organisation - once qualified
	Wish to gain employment in a coaching environment - coaching qualification is entry requirement to employment
	Wish to use qualification for teaching (e.g. applicant is a teacher)
	Other

Club Affilliation

	Please complete the following details about the organisation where you currently coach / are linked with:
	Organisation name:

	Position held (e.g. club secretary, coach, player):
	Address:
	Postcode:
	Telephone number:
	Email address:
	Website:

Further Coaching Details

	Which county of Yorkshire and Humber do you deliver the majority of your coaching activity in?
	North Yorkshire		South Yorkshire
	West Yorkshire		Humber

	Which borough (s) of North Yorkshire do you currently coach in? Please select as many as apply
	North - Craven		North - Harrogate		North - Ryedale		North- Selby
	North - Hambleton		North - Richmond		North - Scarborough		North - York

	Which borough (s) of West Yorkshire do you currently coach in? Please select as many as apply
	West - Bradford		West - Kirklees		West - Wakefield
	West - Calderdale		West - Leeds

	Which borough (s) of South Yorkshire do you currently coach in? Please select as many as apply
	South - Barnsley		South - Doncaster		South - Rotherham		South - Sheffield

	Which borough (s) of Humber do you currently coach in? Please select as many as apply
	Humber - City of Kingston upon Hull		Humber - East Riding of Yorkshire		Humber - North East Lincolnshire		Humber - North Lincolnshire

	Which county of Yorkshire and Humber do you plan to deliver the majority of your coaching activity in?
	North Yorkshire		West Yorkshire		South Yorkshire		Humber

	Which borough (s) of North Yorkshire do you plan to coach in? Please select as many as apply
	North - Craven		North - Harrogate		North - Ryedale		North- Selby
	North - Hambleton		North - Richmond		North - Scarborough		North - York

	Which borough (s) of West Yorkshire do you plan coach in? Please select as many as apply
	West - Bradford		West - Kirklees		West - Wakefield
	West - Calderdale		West - Leeds

	Which borough (s) of South Yorkshire do you plan to coach in? Please select as many as apply
	South - Barnsley		South - Doncaster		South - Rotherham		South - Sheffield

	Which borough (s) of Humber do you plan to coach in? Please select as many as apply
	Humber - City of Kingston upon Hull		Humber - East Riding of Yorkshire		Humber - North East Lincolnshire		Humber - North Lincolnshire

Your Coaching Activity

	How would you describe your main coaching activity? Please select all that apply
	Full time - Paid		Part-time - Volunteer
	Part-time - Paid		Sessional/casual
	Full time - Volunteer		Not currently delivering coaching

	How many paid hours do you work each week? Please write in below

	How many volunteer hours do you deliver each week? Please write in below

Highest Level of Qualification Held

	Which (if any) of the following qualifications to you currently hold?
		Yes - Sport/fitness related	Yes - Non sport/fitness related
	Entry level certificate
	GCSE/CSE/O-level
	GNVQ
	A levels/Highers
	Vocational Certificate of Education
	BTEC
	Apprenticeship
	S/NVQ Level 1
	S/NVQ Level 2
	S/NVQ Level 3
	VRQ
	Certificate of Higher Education
	Higher  National Diploma/Certificate
	Foundation Degree
	Honours Degree
	Postgraduate qualification
	Professional management qualification

	Do you currently hold any of the following sports/fitness related qualifications
	Level 1 Fitness qualification		UK Coaching certificate - Level 2
	Level 2 Fitness qualification		UK Coaching certificate - Level 3
	Level 3 Fitness qualification		National Governing Body Awards
	Community Sports Leadership Award		APIOL - Accredited Practitioner of Outdoor Learning
	UK Coaching certificate - Level 1

Your Bursary Referee

Please note that in order to endorse your application we need to clarify your involvement with a sporting organisation and your intention to deliver coaching in Yorkshire and Humber.

	Please provide the Name and contact details of a referee from your coaching/sporting environment, National Governing Body or County Sports Partnership:
	Name:
	Position
	Organisation
	Address
	County
	Postcode
	Telephone number:
	Email address:

	How did you find out about the Coaching Bursary? Please select as many as apply
	Coaching / sporting environment
	County Sports Partnership
	Poster
	Flier
	Website
	Other Project (e.g. SPRINT, Women Into Coaching, Coachability)
	Other

	Please provide details of website used:

	Please specify which 'other' way you found out about the Coaching Bursary:

Other Information

As the Sector Skills Council for the Active Leisure and Learning sector, SkillsActive and the National Skills Academy are dedicated to the needs of organisations in the sector and aim to ensure that learning meets the needs of those that we represent.

	Would you like to receive further information about the work of SkillsActive/The National Skills Academy?
	Yes
	No

	We will store your details and only contact you via the method(s) you indicate below to keep you informed about activities relevant to the Active Leisure and Learning sector (including news, events, training, research, consultations)
		Yes	No
	By email
	By post
	By telephone

	SkillsActive Services Ltd, our trading arm and subsidiary companies are also working towards the same goals as SkillsActive, the sector skills council and may contact you with information on products and services relevant to Active Leisure and Learning e.g. training and development tools.
		Yes	No
	I want to receive information from SkillsActive Services Ltd and subsidiary companies by post
	I want to receive information from SkillsActive Services Ltd and subsidiary companies by telephone
	I want to receive information from SkillsActive Services Ltd and subsidiary companies by email

Thank you for taking the time to complete this application form, we will be in contact with you shortly.

Unfortunately you are not eligible for funding under this programme, may we take this opportunity to thank you for your interest in the programme