Pre-Course Application Form STA Swim Teacher Course

Pre-Course Application Form

LED Community Leisure
Please complete this form in order to apply to undertake an STA course with LED Community Leisure.
Qualification
Course Reference Number
STA Reference Number (If Known)
Date of Birth

MonthDayYear
Date
Title
Name

First NameLast Name
Address
First line of address
Town
County
Postcode
Email Address
example@example.com
Telephone Number
Gender

MaleFemaleTransgender NonBinaryDecline to answer
Ethnicity

WhiteMixed/Multiple thnic roupsAsian/Asian BritishBlack/African/Caribbean/Black BritishDecline to answer
Do you consider yourself to have a disability? Please indicate below all which apply

I do not have a disabilityVisual impairmentLearning difficultyPhysical disabilityMental illhealthHearing impairmentOtherDecline to answer
Do you require any reasonable adjustments to be made for you to participate in the course?

Yes (please specify)No
Please specify any reasonable adjustments here:
Do you hold any previous STA qualifications? If so, please specify these below.
Where did you hear about this course? Please indicate all which apply.

On STA’s websiteOn your training provider’s websiteSocial mediaFrom a marketing/newsletter emailWord of mouth
What is your highest level of qualification to date?

NVQ Level 1, Foundation GNVQ, Basic Skills, or equivalentNVQ Level 2, Intermediate GNVQ, RSA Diploma, or equivalentGCSE, O Level, CSE, Foundation Diploma, or equivalentNVQ Level 3, Advanced GNVQ, BTEC National Diploma, or equivalentAS or A Level, Higher school certificate, SVQ 3, or equivalentNVQ Level 4 or 5, HNC BTEC Higher Level, SVQ 4Degree, e.g. BSc, BAHigher Degree, e.g. MSc, PGCE, PhDProfessional qualificationForeign qualificationNo formal qualifications
Current Occupation
Has a doctor advised you that you shouldn’t currently exercise?

YesNo
Are you pregnant?

YesNo
If you've answered yes to either of the above, you must discuss this with your course tutor, as you may need medical clearance before attending this course or participating in any physical aspects of it.
Learner Declaration
The data you have supplied in this form will be processed by the Safety Training Awards approved training centre providing this course. Additionally, Safety Training Awards will also process this data in accordance with regulatory requirements to register and certificate your achievement of a qualification. For more information about how your data is collected, stored and processed, please seek guidance from the approved training centre providing this course, or alternatively see our privacy policy which can be found at: www.sta.co.uk/policies/privacy-policy

Safety Training Awards can be contacted at: www.safetytrainingawards.co.uk/contact-us

The information I have given on this form is correct at the time of completion and I will endeavour to inform Safety Training Awards as appropriate if my circumstances change.
Learner Signature

Powered by Jotform SignClear
Date

MonthDayYear
Date
To Be Completed by the Course Tutor
Has the learner’s identity been confirmed?

YesNo
Photo ID Provided

PassportDriving LicenceStudent ID CardCompany ID CardTravel PassOther (please specify)
Tutor Signature

Powered by Jotform SignClear
Date

MonthDayYear
Date
Anchor House, Birch Street, Walsall, WS2 8HZ, United Kingdom | +44 (0)1922 645097 | info@safetytrainingawards.co.uk | www.safetytrainingawards.co.uk

Safety Training Awards Limited, registered office as above, is a company registered in England and Wales (No. 05544759) and is a subsidiary of The Swimming Teachers’ Association, a registered charity (No. 1051631 in England and Wales and SC041988 in Scotland) whose objective is: “The preservation of human life by the teaching of swimming, lifesaving and survival techniques.
Should be Empty:

Pre-Course Application Form

Address

Learner Declaration

To Be Completed by the Course Tutor