Application form for part time programmes
Please refer to the guidance application notes when completing this form
PROGRAMME OF STUDY
POSTGRADUATE CERTIFICATE IN ACADEMIC PRACTICE (PCAP)
University of Hull Staff
Start Date*
Sept 20..
*See Note 1 on application notes.
Reason for preference?
Please indicate any operational reasons for the start date, or any
circumstances that we need to consider when allocating cohorts.
We may ask for confirmation of this from your Line Manager.
Personal Information
Surname (Family Name)
Forename(s)
Previous Family Name (if applicable)
Title
 Dr
 Mrs
 Miss  Ms
 Mr  Other …………
Department
Faculty
Campus
Registration Number (if previously/currently a student at the University of Hull)
Date of Birth
Male / Female
Nationality
Ethnic Origin *
Disability *
* See Note 2 and Note 3 on application notes regarding Ethnic
Origin and Disability
Additional
Information
Home Address
Postcode (essential)
Current Post
Job Title
Telephone
Email
Line Manager
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PCAP Application form v4
Teaching Experience and Qualifications
What is your discipline background and teaching area?
How many years / months teaching in higher education have you done? Please give brief details.
Have you previously completed any courses or programmes in teaching and learning professional
development? If so, give brief details:
For any APL claims you wish to be made, please ensure you have included the following details:
o Awarding institution:
Course title:
Module title(s):
Module code(s)
o How many credits were you awarded? Please note: you cannot claim APL for more than 20 credits.
o Does it meet the requirements of the UK Professional Standards Framework?
D1 YES/NO
D2 YES/NO
o Is it a Level 7 course? YES/NO
o Please ensure you attach a transcript of the module(s) you wish to be considered for your APL
claim.
In total, how many teaching hours, in each semester, will you have while on the programme?
Please include lectures, seminars, tutorials, workshops etc that you will be leading.
If your teaching hours are not yet confirmed, please just include confirmation from your line
manager/HoD that you will have at least 30hrs per semester for the duration of the programme.
We will not be able to offer you a place without this confirmation.
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Most recent previous education (See Note 4)
University / college attended (name, town and country)
From mm/yy
To mm/yy
Highest qualification already completed
Date of final
assessment
Subject
Award Type
Examining
Body/Board
Overall
Grade
mm/yy
Are you currently undertaking another qualification? YES / NO
If yes, please state title, start date and scheduled completion date and awarding institution
Emergency Contact
The person you name below will only be contacted in the event of your death or serious illness, and only with the approval of a
senior officer of the University
Full Name (inc Title)
Relationship to you
Contact Address
Postcode
Telephone Number
Email
Head of Department/Area Authorisation
I support the application of the above member of staff to enrol on the PCAP course and will release
him/her from departmental commitments in order that taught sessions may be attended.
By signing this, I also confirm that this colleague will have at least 30 teaching hours per semester for the
duration of the programme.
Signed:
………………………………........................................................ (Head of Department/Area)
(In capitals):
..........................................................................................
Date:
................................…………….............................................
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Declaration (see Note 5)
I confirm that the information given on this form is true, complete and accurate to the best of my
knowledge and that no information requested or other relevant information has been omitted. I accept
that, if I do not fully comply with these requirements the University of Hull reserves the right to cancel
my application/registration and that I shall have no claims against the University in relation thereto. I
agree to inform the University if any details change after submission of this form. If accepted to study at
the University of Hull I agree to abide by the Statutes, Regulations and Ordinances of the University of
Hull in force throughout the period of study (available at www.hull.ac.uk).
I agree to these details being processed for the purpose of admission and my student record with the
University of Hull and to them being held in electronic and paper format, which will be available to
academic and administrative staff of the University, concerned with all aspects of my chosen programme
of study.
(ESSENTIAL)
Applicant’s Own Signature ……………………………………….…………………………… Date ……….………….
Please return form to: PCAP Programme Administrator
Learning Enhancement & Academic Practice Directorate (LEAP)
Venn Building
University of Hull
HULL HU6 7RX
Department Use Only
Signed by Programme Director:
…………………………………………………….………………
Date:
…………………………………………………………………..
Comments:
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