Education and Training

Coach Licence Application / Data Form

Please complete this form in clearly printed capital letters and return to the RETA in your area. If you have already completed a data form please use this to update any of your details that may have changed.

Club / Local Authority / School / University
Unique Reference Number
Date of Birth	Applicants must be aged 16 and over for Level 1 courses, 14 and over for Children in Athletics courses and 18 or over for Level 2 courses

Title	Mr £ Mrs £ Miss £ Ms £ Dr £ Other
Forenames
Surname
Address
Town/City
County
Post code
Place of Birth
Phone (home)		Phone (work)
Phone (mobile)		E-mail

Please enter details for course(s) you wish to attend below. (Places are subject to availability)

Course Code	Course Name	Date(s) of course	Venue	Fee enclosed	Official use only
				£
				£
				£

Course Fee: Please enclose appropriate course fee (see relevant promotional material for information) making cheques payable to “UK Athletics Ltd”, with your name and address printed clearly on the back of the cheque.

Please return application form and cheque to the appropriate Education and Training Administrator

Additional Qualifications

Please give details of any additional qualifications that you feel are relevant to coaching or athletics. e.g. teaching, tutoring, sport related degree, fitness awards

Date	Qualification gained

This form and the terms and conditions outlined form an agreement between UK Athletics and you, the coach. By signing this form you agree to comply with the terms and conditions and any other rules, procedures, codes of conduct, policies and guidelines of UK Athletics and amends to these that may occur from time to tend. Details of all of these will be maintained on the UKA website.

· I confirm that all the information given is accurate and correct.

· I give UK Athletics permission to carry out police or CRB checks at any time to determine whether I should be issued with a licence or whether any licence issued to me should be returned.

· I have been given the opportunity to read the Terms and Conditions and agree to abide by them and any other applicable rules, procedures, codes of conduct and guidelines of UK Athletics as set out on the UKA website.

· As a UK Athletics licensed coach I agree to abide by the UK Athletics rules as laid down in its rule book and related procedures

Signature

Date

UK Athletics will process the data provided by you fairly and lawfully for the purpose of the proper administration of its Coach Licensing Scheme in accordance with the Data Protection Act 1998. In so doing, UK Athletics may pass your information to the National and Regional Athletics Associations, affiliated bodies, sports organisations (such as Sports Coach UK, UK Sport, Sport England) and any other authority within the UK which has responsibility for coaching provision for the purpose of informing them of the status of your coach licence.

In addition, UK Athletics may pass your information to:

our official sponsors, their associated companies and other carefully selected organisations who may use it (and pass it to other companies world-wide so that they may use it) now or in the future for profiling and to keep you informed (possibly by telephone, email or SMS) of their products and services and to compile market research information and statistics and to use it for any other aspect of their business. If you do not wish us to use your information for these purposes please tick here □

Equity Policy

It would be helpful to UK Athletics in establishing the development of our equity policy if you would complete this part of the form. All information is confidential.

Gender
	Female	£	Male	£	(Please tick as appropriate)

Ethnic origin