VOLUNTEER CLUB LEADER TRAINING APPLICATION / ENROLMENT FORM LA: 1. Full name (given name, surname) 2. Male / Female (please circle) 3.

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1 VOLUNTEER CLUB LEADER TRAINING APPLICATION / ENROLMENT FORM For SpEC office use only Number: LA: Section 1: Personal Details 1. Full name (given name, surname) 2. Male / Female (please circle) 3. Date of birth: 4. Address: 5. Postcode: 6. Mobile number: 7. Borough: address: Please make sure this is an address you check regularly. Section 2: Emergency Contact Details Please provide the details of a person who the City of London Corporation can contact in case of an emergency. 1. Name of emergency contact 2. Relationship to you (e.g. family member, partner, friend, neighbour) 3. Mobile number: 4. Home telephone: Page 1

2 Section 3: Equal opportunities and diversity We welcome all learners onto the volunteer training programme and embrace the diversity this brings to the Speaking English with Confidence project. Please help us respond to your needs by filling in the sections below. This information is treated sensitively. 1. Do you consider yourself to have a Disability or Learning Difficulty or Health Problem? Yes No (please tick) If yes, would you like to discuss your support needs with a member of staff? Yes No (please tick) If yes, please indicate how /when you would like a member of staff to contact you Section 4: Ethnicity 1. What is your ethnic group? Please tick the box that best describes your ethnic group. White English/Welsh/Scottish/N. Irish /British Irish Gypsy or Irish Traveller Black / African / Caribbean Caribbean African Other Black/African/Caribbean background Other white background Asian Indian Pakistani Bangladeshi Chinese Mixed / Multiple Ethnic Group White and Black Caribbean White and Black African White and Asian Other mixed/multi ethnic background Other Asian background Other Ethnic Group Arab Turkish Kurdish Other ethnic group Page 2

3 Section 6: Employment details Are you? 1. In paid employment? Yes No (please tick) If yes, how many hours per week? 2. Not in paid employment and looking for work? Yes No (please tick) 3. Not in paid employment and not looking for work/not available to start work. Yes No (please tick) If yes, please give reason: Student Retired Childcare Caring responsibilities Other 4. Do you have a host organisation, willing to host you and a language club? Yes No (please tick) If yes, name and address of organisation If no, please state when you are able to volunteer. Please tick all boxes when you are available. Monday Tuesday Wednesday Thursday Friday Saturday Sunday Morning Afternoon Evening Page 3

4 Section 7: Motivation and existing skills and experience The SpEC project team will use the information you give below to determine how we can best support you to successfully complete the training course and your suitability for the Level 3 Award qualification. 1. Why do you want to be a SpEC volunteer? 2. Please state your qualifications: G.C.S.E A levels Undergraduate degree Postgraduate degree Vocational qualifications (course and level) Other ESOL E1 E2 E3 L1 L2 3. We are looking for volunteers with the following: Excellent communication skills Excellent spoken English Ability to get on with a diverse group of people Commitment to developing others A friendly an approachable manner Commitment to 30hrs club time Please outline below how you feel you meet these requirements: Page 4

5 4. All volunteers who enrol on the training course will be given the opportunity to accredit their work to achieve the City and Guilds Level 3 Award in Learning Support but this is not a compulsory element of the training. Are you interested in working towards this qualification? Yes No (please tick) Section 8: Marketing Information How did you hear about the SpEC project and the volunteer training course? Please tick a box below: Poster in a community centre Online Place of worship Word of mouth Local Authority In the press Place of employment Other: Page 5

6 Section 9: Declaration and signature Thank you for applying to the volunteer club leader training course. We aim to respond to all applicants within a week of receiving their form to confirm their place on the training course. By accepting a place, you agree to attend all planned sessions, to a total of 30 hours of face-to-face tuition. You also agree to a minimum commitment of 30 hours of voluntary work leading a Speak English with Confidence (SpEC) club in a community setting. If you cannot attend any session, due to exceptional circumstances, it is your responsibility to inform a member of the project staff as soon as possible. Many of the volunteering positions available within the SpEC initiative involve working with vulnerable adults and/or children and, as such, any participant on the volunteer club leader training programme will be required to complete a DBS check. At no time will your personal information be passed to organisations for marketing or sales purposes. Any information which you provide us will be recorded by the City of London Corporation, during the period that you remain as a volunteer and for a period of 5 years thereafter. It will be used to record the work, interest and experience of volunteers, and will also be used for statistical analysis and to inform you of matters relating to volunteering with the City of London Corporation. It may also be used by staff for their use in contacting you regarding volunteering. The City of London may also share your information with SpEC stakeholders, Local Authorities and community volunteering partners as well as organisations performing research and statistical work on behalf of the City of London and the Boroughs. A copy of this form will be retained by this division for a period of 5 years following the end of your volunteer position. Under the Data Protection Act 1988, you may also request details of your Personal Data held by the City of London. I have read and understood the role profile Contact preferences please tick any of the following that apply to you: I do not wish to be contacted about other volunteering opportunities I do not wish to be contacted for survey or research I do not wish to be contacted by post I do not wish to be contacted by telephone I do not wish to be contacted by . Signature of applicant Date Please return this form to: Joella Hope, SpEC project, Adult Skills and Education, Department of Community and Children s Services, Guildhall (North Wing) 5 th Floor - PO Box 270, London EC2P 2EJ. Local Authority stamp: Page 6

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