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Application Form- Hampden

Application Form- Hampden. Please complete the form in block capitals and return to the Football Development Department, Hampden Park, Glasgow, G42 9AY. . Title: Mr Mrs Miss Ms SFA ID Number (if known):. Surname: Name:.

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Application Form- Hampden

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  1. Application Form- Hampden Please complete the form in block capitals and return to the Football Development Department, Hampden Park, Glasgow, G42 9AY. Title: Mr Mrs Miss Ms SFA ID Number (if known): Surname:Name: E-mail:(This is essential as all correspondence for this course is via email) Home telephone: Daytime telephone: Full address: Postcode: Date of Birth: Place of Birth: Club: Quality Mark Approved tick if applicable Working in Football: Yes No Club: Role: Please provide details of any medical conditions, disabilities, dietary requirements or specific needs: Course Details (if applying for more than one course from different authorities, please complete separate forms for each authority) Physical Prep (children) (£72) Physical Prep (Adult) (£72) Children’s Award (£228) Advanced Children’s Licence (£1,170) Goalkeeping Intermediate Certificate (£55) Goalkeeping Basic Licence (£72) Goalkeeping Licence Intro (£540) Goalkeeping Licence Assessment (£480) C Licence (£228) B Licence Introduction (£1,170) B Licence Assessment (£456) A Licence Introduction (£1,320) A Licence Assessment (£780) Elite Youth A Licence (£1,584) Pro Licence (£5,200) Reassessments (Various) Coaching Footballers with Disabilities (£50) CPD Event*(Various) Any other Event* (Various) Date of Event/Course: Venue: Cost: * If Event please give name of event: Page 1 of 2 PTO For Office use only: Qualified: Application Form Complete Accepted: Quality Mark Paid in full: InvoiceInvoice No: Invoice Date: Invoice paid: Payment method: Comments:
  2. Application Form- Hampden Payment Details Bacs: Credit Card: Debit Card: Invoice : (Complete details below) Card Type: Name on Card: Card Number: Valid from: Expiry date: Invoice/Receipt Details (if different from personal details/third party payment) Title: First Name: Surname: Organisation : Full address: Postcode: Telephone: E-mail address: Equity Monitoring Terms and Conditions The Scottish FA must receive applications for licence courses no later than 14 days prior to course commencement. Full payment is excepted on application. Fees must be paid fully 14 days in advance to secure a place on the course, otherwise your place will be offered to our wait-listed candidates. Reassessments of all courses will only be permitted following a 6 month elapsed period from the previous assessment. Payments for Events must be made at least 2 days prior to event starting and fees must be paid on application. The Scottish FA reserves the right to cancel or amend the arrangements for any course or event. Should this be the case, course members unable to transfer to an alternative course, will be issued with a full refund. Intimation of cancellation on a course member’s part for licence courses must be given in writing and must be received by the Scottish FA at least 14 days prior to course commencement. In this event a full refund will be given. Cancellation within the 14 day period prior to a course will only be refunded at the discretion of the Coach Education Director if proof is provided of mitigating circumstances. The validity of coaching licences is limited in time. To keep the licence live you must register and participate in the Scottish FA’s Continuous Professional Development (CPD) scheme which requires a minimum requirement of15 hours CPD within three years. This requirement is compulsory to keep your licence valid. The Scottish FA is strongly committed to equal opportunities for all participants involved in its coach education programme. It is the policy of the Scottish FA to ensure that all course participants receive equal treatment regardless of age, gender, marital status, employment status, social class, colour, race, ethnic or national origin, religious belief or disability. Your information will be used by the Scottish FA to maintain and update course attendance records I do not wish to be included in future mailings on coach education From time to time, photographs and video footage may be taken during events/courses for promotionalpurposes. If you wish to opt out of this please tick the box From time to time we will make your information available regarding third party enquiries regarding licence/award holders. If you wish to opt out please tick the box. I have read and abide with the above Terms and Conditions Signed:Date:
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