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: 2 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: 3 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. 4 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): 5