This is the application form for the Recruit into Coaching (RiC) Programme.   The RiC programme is being implemented by Sport England and the Youth Sports Trust with support from sports coach UK and SkillsActive on behalf of the Department for Culture Media and Sport.The overall aim of the programme is to recruit, train and deploy 10,000 new volunteer coaches by 2011 and is available in selected boroughs across England. By completing this application form, you are expressing your interest in the programme and agreeing to be contacted by your local representative to discuss your potential involvement in the scheme.  Please complete all fields accurately and honestly. We look forward to speaking with you soon!

Your Contact Details

	Please complete your details below:
	*Title:
	*First name:
	*Surname:
	Street number/house name:
	Street:
	Town:
	City
	County:
	*Postcode:
	*Telephone number:
	Mobile number:
	Personal email:

Fields marked with * are compulsory and must be answered

	Which of the following eligible boroughs in London do you live in?
	Islington		Tower Hamlets		Haringey
	Lambeth		Newham		Waltham Forest
	Southwark		Barking and Dagenham		Brent
	Camden		Greenwich		Hammersmith and Fulham
	Hackney		Lewisham

	Which ward in the borough of Islington do you live in?
	Barnsbury		Highbury East		St George's
	Bunhill		Highbury West		St Mary's
	Caledonian		Hillrise		St Peter's
	Canonbury		Holloway		Tollington
	Clerkenwell		Junction
	Finsbury Park		Mildmay

	Which ward in the borough of Lambeth do you live?
	Bishop's		Herne Hill		Streatham Hill
	Brixton Hill		Knights Hill		Streatham South
	Clapham Common		Larkhall		Streatham Wells
	Clapham Town		Oval		Thornton
	Coldharbour		Prince's		Thurlow Park
	Ferndale		St Leonards		Tulse Hill
	Gipsy Hill		Stockwell		Vassal

	Which ward in the borough of Southwark do you live?
	Brunswick Park		Faraday		Riverside
	Camberwell Green		Grange		Rotherhithe
	Cathedrals		Livesey		South Bermondsey
	Chaucer		Newington		South Camberwell
	College		Nunhead		Surrey Docks
	East Dulwich		Peckham		The Lane
	East Walworth		Peckham Rye		Village

	Which ward in the borough of Camden do you live?
	Belsize		Gospel Oak		Killburn
	Bloomsbury		Hampsted Town		Kings Cross
	Camden Town with Primrose Hill		Haverstock		Regents Park
	Cantelowes		Highgate		St Pancras abd Somers Town
	Fortune Green		Holborn and Covent Garden		Swiss Cottage
	Frognal and Fitzjohns		Kentish Town		West Hampstead

	Which ward in the borough of Hackney do you live?
	Brownswood		Hackney Downs		Queensbridge
	Cazenove		Haggerston		Springfield
	Chatham		Hoxton		Stoke Newington Central
	Clissold		Kings Park		Victoria
	Dalston		Leabridge		Wick
	De Beauvoir		Lordship
	Hackney Central		New River

	Which ward in the borough of Tower Hamlets do you live?
	Bethnal Green North		East India and Lansbury		Spitalfields and Banglatown
	Bethnal Green South		Limehouse		St Dunstan's and Stepney Green
	Blackwall and Cubitt Town		Mile End and Globe Town		St Katherine's and Wapping
	Bow East		Mile End East		Weavers
	Bow West		Millwall		Whitechapel
	Bromley-by-Bow		Shadwell

	Which ward in the borough of Newham do you live in?
	Beckton		East Ham South		Plaistow North
	Boleyn		Forest Gate North		Plaistow South
	Canning Town North		Forest Gate South		Royal Docks
	Canning Town South		Green Street East		Stratford and New Town
	Custom House		Green Street West		Wall End
	East Ham Central		Little Ilford		West Ham
	East Ham North		Manor Park

	Which ward in the borough of Barking and Dagengam do you live in?
	Abbey		Gascoigne		River
	Alibon		Goresbrook		Thames
	Beacontree		Heath		Valence
	Chadwell Heath		Longbridge		Village
	Eastbrook		Mayesbrook		Whalebone
	Eastbury		Parsoles

	Which ward in the borough of Greenwich do you live in?
	Abbey Wood		Eltham West		Plumstead
	Blackheath Westcombe		Glyndon		Shooters Hill
	Charlton		Greenwich West		Thamesmead Moorings
	Coldharbour and New Eltham		Kidbrooke with Hornfair		Woolwich Common
	Eltham North		Middle Park and Sutcliffe		Woolwich Riverside
	Eltham South		Peninsular

	Which ward in the borough of Lewisham do you live in?
	Bellingham		Evelyn		New Cross
	Blackheath		Forest Hill		Perry Vale
	Brockley		Grove Park		Rushey Green
	Catford South		Ladywell		Sydenham
	Crofton Park		Lee Green		Telegraph Hill
	Downham		Lewisham Central		Whitefoot

	Which ward in the borough of Haringey do you live in?
	Alexandra		Hornsey		Tottenham Green
	Bounds Green		Muswell Hill		Tottenham Hale
	Bruce Grove		Noel Park		West Green
	Crouch End		Northumberland Park		White Hart Lane
	Fortis Green		Seven Sisters		Woodside
	Harringay		St Ann's
	Highgate		Stroud Green

	Which ward in the borough of Waltham Forest do you live in?
	Cann Hall		Hale End and Highams Park		Leyton
	Cathall		Hatch Lane		Leytonstone
	Chapel End		High Street		Markhouse
	Chingford Green		Higham Hill		Valley
	Endlebury		Hoe Street		William Morris
	Forest		Larkswood		Wood Street
	Grove Green		Lea Bridge

	Which ward in the borough of Brent do you live in?
	Alperton		Kensal Green		Queensbury
	Barnhill		Kenton		Stonebridge
	Brondsbury Park		Kilburn		Sudbury
	Dollis Hill		Mapesbury		Tokyngton
	Dudden Hill		Northwick Park		Welsh Harp
	Fryent		Preston		Wembley Central
	Harlesdon		Queens Park		Willesdon Green

	Which ward in the borough of Hammersmith and Fulham do you live in?
	Addison		Hammersmith Broadway		Sands End
	Askew		Munster		Shepherds Bush Green
	Avonmore and Brook Green		North End		Town
	College Park and Old Oak		Palace Riverside		Wormholt and White City
	Fulham Broadway		Parsons Green abd Walham
	Fulham Reach		Ravenscourt Park

Your Personal Details

	Gender: Please ü one only
	Male		Female

*Date of Birth (dd/mm/yy)

	Ethnic background: Please ü one only
	White /White British		Black/Black British		Other ethnic background
	Asian/Asian British		Chinese
	Mixed ethnic background		Would rather not say

If other, please specify:

Fields marked with * are compulsory and must be answered

About You

	Do you consider yourself to have a long term disability or health problem? Please ü one only
	Yes		No		Don't know

	If yes, which of the following disabilities/health problems do you consider yourself to have?
	Visual impairment		Emotional/behavioural difficulties		Multiple disabilities
	Hearing impairment		Mental health difficulty		Other
	Disability affecting mobility		Temporary disability after illness e.g. post viral or accident		Don't Know
	Other physical disability		Profound complex disabilities
	Other medical condition e.g. epilepsy		Aspergers syndrome

	Do you consider yourself to have a learning difficulty? Please ü one only
	Yes		No		Don't Know

	If yes, which of the following learning difficulties do you consider yourself to have?
	Moderate learning difficulty		Dyscalculia		Multiple learning difficulties
	Severe learning difficulty		Other specific learning difficulty		Other
	Dyslexia		Autism spectrum disorder		Don't Know

Your Employment Status

	What is your current employment status?
	Full time employee		Full time volunteer		Student (FT/PT)
	Part time employee		Part time volunteer		Other inactive
	Self Employed		Unemployed

	Are you currently working in the sport and leisure sector?
	Yes		No		Don't Know

	Are you currently volunteering in a sport and leisure environment?
	Yes		No		Don't Know

How many voluntary hours do you currently deliver each week?

Participation in Sport

	Do you currently participate in sport?
	Yes		No		Don't Know

	Which sport (s) do you currently participate in? Please ü as many as apply
	Athletics		Golf		Rugby Union		Table Tennis
	Badminton		Gymnastics		Rowing		Tennis
	Basketball		Hockey		Swimming Coaching		Triathlon
	Canoeing		Judo		Swimming Synchro		Volleyball
	Cricket		Netball		Swimming Water Polo		Other
	Cycling		Orienteering		Swimming Diving
	Equestrian		Rounders		Swimming Aquatics Teaching
	Football		Rugby League		Squash

If other, please specify

Planned Coaching Activity

	Do you currently deliver coaching?
	Yes		No		Don't Know

	Which sport (s) do you currently deliver coaching in? Please ü as many as apply
	Athletics		Hockey		Swimming Water Polo
	Badminton		Judo		Swimming Diving
	Basketball		Netball		Swimming Aquatics Teaching
	Canoeing		Orienteering		Squash
	Cricket		Rounders		Table Tennis
	Cycling		Rugby League		Tennis
	Equestrian		Rugby Union		Triathlon
	Football		Rowing		Volleyball
	Golf		Swimming Coaching		Other
	Gymnastics		Swimming Synchro

If other, please specify

	Which sport (s) are you interested in coaching in the future? Please ü as many as apply
	Athletics		Hockey		Swimming Water Polo
	Badminton		Judo		Swimming Diving
	Basketball		Netball		Swimming Aquatics Teaching
	Canoeing		Orienteering		Squash
	Cricket		Rounders		Table Tennis
	Cycling		Rugby League		Tennis
	Equestrian		Rugby Union		Triathlon
	Football		Rowing		Volleyball
	Golf		Swimming Coaching		Other
	Gymnastics		Swimming Synchro

If other, please specify

	Which of the following eligible boroughs in London would you be willing to deliver coaching in?
	Islington		Hackney		Greenwich		Brent
	Lambeth		Tower Hamlets		Lewisham		Hammersmith and Fulham
	Southwark		Newham		Haringey
	Camden		Barking and Dagenham		Waltham Forest

Please note that the Recruit into Coaching programme aims to address local needs through the skills of local people.  Therefore, the borough in which you live should be your primary coaching borough, although coaching does not have to be restricted to this area.

	Which days of the week would you be willing to deliver coaching?
	Monday		Wednesday		Friday		Sunday
	Tuesday		Thursday		Saturday

	What times are you available to coach?
	Mornings		Afternoons		Evenings

How many hours of coaching would you be willing/able to deliver each week?

Education and Training

	Do you hold any sports coaching or leadership qualifications? Please ü as many as apply
	NGB Level 1		UKCC Level 1		NVQ Level 2		Junior Sports Leadership Award
	NGB Level 2		UKCC Level 2		NVQ Level 3		Other
	NGB Level 3		UKCC Level 3		Community Sport Leadership Award		None

If other, please specify

Please note: The Recruit into Coaching Programme does not require applicants to hold coaching/leadership qualifications

	Approximately when did you achieve your last coaching/leadership qualification?
	In the last 12 months		3 to 4 years ago		Don't know
	1 to 2 years ago		4 to 5 years ago
	2 to 3 years ago		Over 5 years ago

	What type (s) of qualifications would you be interested in undertaking as part of the Recruit into Coaching Programme? Please ü as many as apply
	Community development		UK Coaching Certificate (Level 1)
	Sports leadership		Coaching workshops (e.g. sports coach UK)

	Are there any specific courses/qualifications that you would like to be funded through the Recruit into Coaching programme?

Your Referee

Please provide the details of two people who can be contacted to give a reference for you. You MUST provide the contact details for at least 1 referee.  The second referee is optional, however providing an alternative contact helps us in obtaining a reference and could speed up the application process e.g. where a referee proves difficult to contact. A referee may be a sports related contact, a colleague, teacher, guardian, advisor etc, however please ensure that they are aware that you have listed them as a referee in your application.

	Referee One
	*Name:
	*Relationship to you:
	*Telephone number:
	Email address:

Fields marked with * are compulsory and must be answered

	Referee Two
	Name:
	Relationship to you:
	Telephone number:
	Email address:

	Why do you want to participate in the Recruit into Coaching Programme?

Terms and Conditions

Please read the following section carefully and identify whether you agree to the terms by selecting the corresponding box.

I confirm that if selected for the Recruit into Coaching programme, I will:

	Complete a Criminal Records Bureau (CRB) check

	Abide by the code of conduct and attend all induction and training sessions

	Agree to my contact details and data being shared with relevant partners for information, reporting and monitoring purposes only

	Agree to any photos taken of me whilst participating in the Recruit into Coaching programme to be used in relevant promotional materials (including website material)

Are you eligible to work in the UK?
Yes		No		Don't Know

Please note that the details contained in this form will only be used in accordance with the Recruit into Coaching Programme.

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

	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.