Amendment to an Approval to Run an Access to HE Diploma
(Addendum)
When completing this form, it is important that the original Approval to Run Form is available as
reference must be made to it.
A provider should complete the appropriate sections of this form when making any requests for
amendment to an Access to HE Diploma which is presently offered by the provider.
A different form should be completed for each Access to HE Diploma.
This completed form should be attached as an Addendum to the original Approval to Run Form held by
both the provider and the AVA.
Please return to Carol Young at c.young@certa.org.uk
1. Provider Information
Provider Name:
Site/Campus:
Date of original
Approval to Run:
Date of this
Application for
Amendment:
Access to HE
Diploma to which
this Addendum
relates:
Name:
Person submitting
this application:
Role:
Email:
Amendment to an Approval to Run an Access to HE Diploma (Addendum)
2. Amendment to Marketing Title:
Original Marketing Title:
Revised Marketing Title:
To be effective from:
I confirm that all marketing (including the content of the website) will be amended accordingly to reflect
this title:
Signed:
Print Name:
3. Amendment to Start Dates:
Original Start Dates:
Revised Start Dates:
I confirm that all marketing (including the content of the website) will be amended accordingly to reflect
the revised start dates:
Signed:
Print Name:
4. Amendment to Mode of Delivery:
Original Mode of Delivery was:
Revised Mode of Delivery will be:
Full-time* Part-time* Blended* On-line/Distance*
Evening* (*delete as appropriate)
Full-time* Part-time* Blended* On-line/Distance*
Evening* (*delete as appropriate)
To be effective from:
I confirm that all marketing (including the content of the website) will be amended accordingly to reflect
the revised modes of delivery:
Signed:
Print Name:
5(a) Changes to Course Team, Course Management etc. (Please advise of any additions to
tutor team, tutors no longer delivering on the diploma, change of role etc).
Name:
Email:
Role/Responsibility (eg Curriculum Leader, Tutor,
Internal Moderator):
Unit(s) to be delivered:
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Indicate the professional qualifications (including
occupational or vocational qualifications of the
person (eg PGCE, CRLLS, DTLLS, D32 etc) if the
tutor is new to the team.
Give further explanation of the change and when it
is to be effective from:
I confirm that both the academic and professional qualifications of the person named above have been
checked and details are held within the college by the appropriate department (eg HR Department)
Signed:
Print Name:
5(b) Changes to Course Team, Course Management etc. (Please advise of any additions to
tutor team, tutors no longer delivering on the diploma, change of role etc).
Name:
Email:
Role/Responsibility (eg Curriculum Leader, Tutor,
Internal Moderator):
Unit(s) to be delivered:
Indicate the professional qualifications (including
occupational or vocational qualifications of the
person (eg PGCE, CRLLS, DTLLS, D32 etc) if the
tutor is new to the team.
Give further explanation of the change and when it
is to be effective from:
I confirm that both the academic and professional qualifications of the person named above have been
checked and details are held within the college by the appropriate department (eg HR Department)
Signed:
Print Name:
5(c) Changes to Course Team, Course Management etc. (Please advise of any additions to
tutor team, tutors no longer delivering on the diploma, change of role etc).
Name:
Email:
Role/Responsibility (eg Curriculum Leader, Tutor,
Internal Moderator):
Unit(s) to be delivered:
Indicate the professional qualifications (including
occupational or vocational qualifications of the
person (eg PGCE, CRLLS, DTLLS, D32 etc) if the
tutor is new to the team.
Give further explanation of the change and when it
is to be effective from:
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I confirm that both the academic and professional qualifications of the person named above have been
checked and details are held within the college by the appropriate department (eg HR Department)
Signed:
Print Name:
Role:
If there are further amendments please copy and paste the above box into this form or contact
Carol Young at c.young@certa.org.uk who will forward a longer version of this form to you.
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6. Please state any other amendments not indicated above and the reason for change.
7. Declaration
I declare that:
I am authorised by the Centre named in Section 1 to supply the information provided in this
application:
Yes
The information is, to the best of my knowledge and belief, true and complete:
Yes
The above named Centre agrees to comply with the Certa Centre Agreement:
Yes
The above named Centre agrees to ‘deliver recognised Access to HE courses in
accordance with the requirements of the definitive Diploma documentation (QAA Licence
Criteria 4.31a)’:
Yes
I agree to inform Certa immediately should any changes occur to the information supplied
in this application or further amendments are required.
Yes
Signature:
Name:
Position:
Date:
For Certa office use only (further action required
Element
Signature
Date
Comments
Form approved by
Access to HE
Manager/Access
Development Officer:
External Moderator
advised of
amendments:
QAA Database has
been amended as
required (eg mode of
delivery/change of
campus):
Other action(s)
required (please state
with deadline and
person responsible):
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