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. You will hopefully have been directed to this page by a representative from your coaching/sporting environment, your National Governing Body of Sport or another coaching project in Yorkshire and Humber.  Please note, not all applications will be successful - an endorsement from any of the organisations outlined above and someone who manages your coaching time in the sporting environment will help to ensure your application is successful. Please note: 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 Jen Barnes (coaching bursary administrator) at jen.barnes@sportactivensa.co.uk. Good Luck!

Please note that due to high levels of demand, we are only taking applications for current UKCC endorsed courses i.e. angling, athletics, badminton, basketball, canoeing, cricket, cycling, equestrian, golf, gymnastics, hockey, judo, netball, orienteeing, rugby league, rugby union, rowing, swimming, squash, table tennis, tennis, triathlon and  volleyball. A reference will be required as part of this application

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 ü one only
	Male
	Female

Age*

	Ethnic background: Please ü one only
	White
	Asian/Asian British
	Mixed ethnic background
	Black/Black British
	Chinese
	Other ethnic background (please specify below)

Your Personal Details

	Do you consider yourself to have a disability / impairment? Please ü one only
	Yes
	No
	Don't know

Your Current Qualifications and Experience

	Which of the following qualifications (if any) have you already achieved? Please ü as many as apply
		Have achieved
	NGB Level 1 Qualification
	NGB Level 2 Qualification
	NGB Level 3 Qualification
	* New NGB UKCC Level 1 Qualification
	* New NGB UKCC Level 2 Qualification
	* New NGB UKCC Level 3 Qualification
	Level 2 NVQ in Coaching, Teaching and Instructing
	Level 3 NVQ in Coaching, Teaching and Instructing
	Level 2 NVQ in Activity Leadership
	Level 2 NVQ in Instructing Exercise and Fitness
	Level 3 NVQ in Advanced Fitness Instructor
	Other (Coaching Related)

Your Current Qualifications and Experience

	Outside of your work in coaching, do you hold any other qualifications at Level 2 or above? (e.g. 5 GCSE grade A-C, A levels, Level 2/3 NVQ, HND, Foundation Degree, BA Honours, PHd, MSc) Please ü one only
	Yes
	No
	Don't know

	Please provide details of the highest level of qualifications held: Please write in below

	Is your highest level qualification (non-coaching) in a sport/fitness related subject?
	Yes
	No
	Don't Know

Your Bursary Application

The section below relates to the coaching qualification that you wish to undertake with the support of the bursary funds.  Please identify the sport and level of qualification that you wish to undertake.

	If successful in your bursary application, which sport would you like to gain your qualification in? Please ü one only
	Angling		Gymnastics		Swimming Synchro
	Athletics		Hockey		Swimming Water Polo
	Badminton		Judo		Swimming Diving
	Basketball		Netball		Swimming Aquatics Teaching
	Canoeing		Orienteering		Squash
	Cricket		Rowing		Table Tennis
	Cycling		Rounders		Tennis
	Equestrian		Rugby League		Triathlon
	Football		Rugby Union		Volleyball
	Golf		Swimming Coaching

Your Bursary Application

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

	Angling
	Level 2

	Athletics
	Level 1
	Level 2

	Badminton
	Level 1
	Level 2

	Basketball
	Level 1
	Level 2

	Canoeing
	Level 1
	Level 2
	Level 3

	Cricket
	Level 1
	Level 2
	Level 3

	Cycling
	Level 1
	Level 2
	Level 3

	Equestrian
	Level 1
	Level 2
	Level 3

	Football
	Level 1

	Golf
	Level 1
	Level 2
	Level 3

	Gymnastics
	Level 1
	Level 2

	Hockey
	Level 1
	Level 2
	Level 3

	Judo
	Level 1
	Level 2
	Level 3

	Netball
	Level 1
	Level 2
	Level 3

	Orienteering
	Level 1

	Rounders
	Level 1
	Level 2

	Rugby League
	Level 1
	Level 2
	Level 3

	Rugby Union
	Level 1
	Level 2
	Level 3

	Rowing
	Level 2
	Level 3

	Swimming - Coaching
	Level 1
	Level 2
	Level 3

	Swimming - Synchro
	Level 1

	Swimming - Water Polo
	Level 1
	Level 2

	Swimming - Diving
	Level 1
	Level 2

	Swimming - Aquatics Teacher
	Level 1
	Level 2

	Squash
	Level 1
	Level 2
	Level 3

	Table Tennis
	Level 1
	Level 2
	Level 3

	Tennis
	Level 1
	Level 2

	Triathlon
	Level 1
	Level 2
	Level 3

	Volleyball
	Level 1

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.

Do you currently hold the relevant entry level qualifications to undertake this qualification?
Yes		No

Your Course

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

	Date:
	Venue:

Please note: You must be registered onto a relevant course before you apply for this funding scheme.

	Would you like to find out more information about the venues and dates of relevant courses?
	Yes
	No

Your Current Coaching Activity

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

	If no, how do you intend to use your new coaching qualification? Please ü 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

	Are you currently affiliated/linked with a coaching/sporting organisation where you can practice your coaching? Please ü one only
	Yes
	No

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

	Position / role:
	Address:
	Postcode:
	Telephone number:
	Email address:
	Website:

Your Coaching Activity

	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 ü 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 ü 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 ü as many as apply
	South - Barnsley		South - Doncaster		South - Rotherham		South - Sheffield

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

	Which borough (s) of Humber do you plan to coach in? Please ü 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 categorise your current coaching activity? Please ü all that apply
	Full time - Paid		Part-time - Volunteer
	Part-time - Paid		Sessional/casual
	Full time - Volunteer		Not currently delivering coaching

Your Coaching Activity

	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

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:
	Telephone number:
	Email address:

	How did you find out about the Coaching Bursary? Please ü 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

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 agree with the following terms and conditions of the Coaching Bursary
	I am prepared to pay for my coaching qualification in full and be reimbursed in accordance with the conditions of this scheme

	I will deliver the specified additional hours of coaching upon completion of my coaching qualification

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