Initial Teacher Training Form ITT 01
Statement of medical history for assessment of Teacher Training students...
Last updated: 9 February 2022
This form should be completed to enable us to consider your suitability to be a provisionally registered teacher. Any false declaration will be considered and may lead to the removal of your eligibility to register.
Students coming for interview should hand the completed form in to the registration desk alongside copies of your qualifications.
Students who have been offered a place should upload the form to their Student Portal.
Please keep a copy of the completed form for your own records.
Title* | |
Surname* | |
Forename* | |
Date of Birth* | |
National Insurance No. * |
Please answer all questions
Please tick either the Yes or No box. For every Yes answer please complete the box overleaf with a detailed legible account of the circumstances that include the sanction, date, reason and full identification of the authority, police force or court concerned.
1. Have you ever been the subject of a bar, partial bar, warning or other action by the Secretary | YES | NO |
2. Do you have any cautions, convictions, reprimands or final warnings which would not be filtered in line with current guidance? The DBS filtering guidance is available on the DBS website at www.gov.uk/government/publications/dbs-filtering-guidance | YES | NO |
3. Have you ever been subject to any disciplinary sanction by any other professional or regulatory | YES | NO |
4. Is there a current employment disciplinary finding against you and/or are you currently the subject | YES | NO |
5. Is there any other information the University of Gloucestershire should know about which may have a bearing upon your suitability to register? (Note: as a registered teacher you will be responsible for upholding and promoting the standards of the profession as set out in the Code of Conduct and Practice for Registered Teachers. Relevant information would include any involvement in activities which could bring the reputation of the profession into disrepute). | YES | NO |
For each Yes answer please provide a detailed, legible account of the circumstances that includes the sanction, date, reason and full identification of the authority, police force or court concerned. If you need more space, please attach and sign an additional sheet.
Question 1 |
Question 2 |
Question 3 |
Question 4 |
Question 5 |
Declaration
I agree to provisional registration by the University of Gloucestershire on commencement of my course of initial teacher training.
I declare that
Name:
Signature:
Date:
Please upload this completed form to your online Student Portal