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CMDA for Schools Application FormThis application form must be completed in one session, you cannot save your answers and then return to it. You should allow around 20 minutes to complete the form. You can email a copy for your records once you have completed your responses by selecting the option at the end of the form.If you have any queries our contact details are: email@example.com or T: 01452 341 829 (office hours)
Section 1 - Terms and Conditions
Please ensure that you have read the Apprenticeship Terms and Conditions, Overview and FAQ documents before completing this application form. It is also essential that you have the full support of your line manager.
Section 2 - Personal Details
Emergency Contact Information
31 - White British, 32 - White Irish, 33 - Gypsy or Irish Traveller, 34 - Any other white background, 35 - White and Black Caribbean, 36 - White and Black African, 37 - White and Asian, 38 - Any other Mixed background, 39 - Indian, 40 - Pakistani, 41 - Bangladeshi, 42 - Chinese, 43 - Any other Asian background, 44 - African, 45 - Caribbean, 46 - Any other Black African or Caribbean Background, 47 - Arab, 98 - Any other ethnic group,
1: No Household Member Is In Employment And The Household Includes One Or More Dependent Children, 2: No Household Member Is In Employment And The Household Does Not Include Any Dependent Children, 3: Learner Lives In A Single Adult Household With Dependent Children, 98: Learner Has Withheld This Information, 99: None Of HHS1 / HHS2 Or HHS3 Applies.
Health Checklist and Additional Support
1. Yes, 2. No, 9. Unknown
01: Visual Impairment, 02: Hearing Impairment, 03: Disability affecting mobility, 04: Other physical disability, 05: Other medical condition (for example epilepsy/asthma/diabetes), 06: Emotional/behavioural difficulties, 07: Mental ill health, 08: Temporary disability after illness (for example post-viral) or accident, 09: Profound complex disabilities, 10: Asperger's Syndrome, 90: Multiple disabilities, 97: Other, 99: Not know/information not provided, 98: No disability,
01: Moderate learning difficulty, 02: Severe learning difficulty, 10: Dyslexia, 11: Dyscalculia, 19: Other specific learning difficulty, 20: Autism spectrum disorder, 90: Multiple learning difficulties, 97: Other, 99: Not know/information not provided, 98: No learning difficulty.
04: Visual impairment, 05: Hearing impairment, 06: Disability affecting mobility, 07: Profound complex disabilities, 08: Social and emotional difficulties, 09: Mental health difficulty, 10: Moderate learning difficulty, 11: Severe learning difficulty, 12: Dyslexia, 13: Dyscalculia, 14: Autism spectrum disorder, 15: Asperger's syndrome, 16: Temporary disability after illness or accident, 93: Other physical disability, 94: Other specific learning difficulty (e.g. dyspraxia), 95: Other medical condition (for example epilepsy / asthma / diabetes), 96: Other learning difficulty, 97: Other disability, 98: Prefer not to say, 99: Not provided, 00: None,