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{\*\generator Msftedit 5.41.15.1515;}\viewkind4\uc1\pard\keepn\s5\cf1\lang2057\f0\fs36 Rugby Union Coach Education Course \par
\fs28 Candidate Application Form and Profile\par
\pard\fs20\par
\pard\qj\f1\fs18 Candidates applying for either the Level 1, 2 or 3 Certificates in Coaching Rugby Union should use this form.  Please complete all sections in BLOCK CAPITALS.  The form should be sent to the \cf2 Approved Centre administering the course\cf1 , with the appropriate fee. Applications received between 1 & 20 days prior to the course cannot be guaranteed due to QCA requirements.\par
\par
This information will be used to register you with the awarding body 1st4sport Qualifications and by the RFU or WRU to support the development of the sport. Please complete all boxes \endash  applications may be returned if information is incomplete or illegible.\par
\pard\f0\fs20\par
\trowd\trgaph108\trrh510\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3
\clvertalc\clcbpat3\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx1440\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx5040\clvertalc\clcbpat3\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx6795\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx10337\pard\intbl\qr\f1 First name*\cell\pard\intbl\cell\pard\intbl\qc\i Surname\i0\cell\pard\intbl\cell\row\trowd\trgaph108\trrh510\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3
\clvertalc\clcbpat3\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx1440\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx3060\clvertalc\clcbpat3\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx4680\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx6855\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx9257\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx10337\pard\intbl\qr Gender*\cell\pard\intbl\qc M/ F\cell\pard\intbl\qr Date of Birth*\cell\pard\intbl\cell Age \par
\i (if 18 or under)\par
\i0\fs18 You \b must\b0  be aged at least 16 to attend a Level 1 & 18 to attend a Level 2 or 3 course.\i\fs20\cell\i0\cell\row\trowd\trgaph108\trrh1062\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3
\clcbpat3\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx1440\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx10337\pard\intbl\qr Full Postal Address*\cell\pard\intbl\cell\row\trowd\trgaph108\trrh510\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3
\clvertalc\clcbpat3\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx1440\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx4333\clvertalc\clcbpat3\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx6795\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx10350\pard\intbl\qr Postcode*\cell\pard\intbl\cell\pard\intbl\qr Contact Telephone No.*\cell\pard\intbl\cell\row\trowd\trgaph108\trrh360\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3
\clvertalc\clcbpat3\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx2533\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx10337\pard\intbl\qr Email Address \par
\f2\fs18 (please print clearly as this will be used for correspondence)\f1\fs20\cell\pard\intbl\cell\row\trowd\trgaph108\trrh360\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3
\clvertalc\clcbpat3\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx2533\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx10337\pard\intbl\qr Mobile Telephone No.\cell\pard\intbl\cell\row\trowd\trgaph108\trrh346\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3
\clvertalc\clcbpat3\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx10337\pard\intbl Please tick the role(s) that you perform and name of club or school:\cell\row\trowd\trgaph108\trrh346\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3
\clvertalc\clcbpat3\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx2533\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx3240\clcbpat3\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx5220\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx5760\clcbpat3\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx7997\clcbpat3\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx10337\pard\intbl\qr Teacher\cell\pard\intbl\cell\pard\intbl\qr Referee\cell\pard\intbl\cell School: \cell\cell\row\trowd\trgaph108\trrh346\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3
\clvertalc\clcbpat3\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx2533\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx3240\clcbpat3\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx5220\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx5760\clcbpat3\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx7997\clcbpat3\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx10337\pard\intbl\qr Youth Club Coach\cell\pard\intbl\cell\pard\intbl\qr FE Student\cell\pard\intbl\cell Club :\cell\cell\row\trowd\trgaph108\trrh360\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3
\clvertalc\clcbpat3\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx2533\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx3240\clcbpat3\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx5220\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx5760\clcbpat3\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx7997\clcbpat3\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx10337\pard\intbl\qr Adult Club Coach\cell\pard\intbl\cell\pard\intbl\qr HE Student\cell\pard\intbl\cell Constituent Body \i\f2\fs16 (e.g. Yorkshire / Eastern Counties etc)\i0\f1\fs20\cell\cell\row\pard\par
\pard\keepn\s6\b\fs24 Course Details\par
\trowd\trgaph108\trrh488\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3
\clvmgf\clvmrg\clvertalc\clcbpat3\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx2713\clvertalc\clcbpat3\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx9553\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx10080\pard\intbl\qr\b0\fs20\par
\cell Level 1 Certificate in Coaching Rugby Union (\'a3100 incl VAT from 1/9/08)\cell\pard\intbl\par
\cell\row\trowd\trgaph108\trrh489\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3
\clvmrg\clvertalc\clcbpat3\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx2713\clvertalc\clcbpat3\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx9553\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx10080\pard\intbl\cell\pard\intbl\qr Level 2 Certificate in Coaching Rugby Union (\'a3176.25 incl VAT)\cell\pard\intbl\cell\row\trowd\trgaph108\trrh488\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3
\clvmrg\clvertalc\clcbpat3\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx2713\clvertalc\clcbpat3\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx9553\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx10080\pard\intbl\cell\pard\intbl\qr Level 3 Certificate in Coaching Rugby Union \par
Apply to judyweavers@rfu.com\cell\pard\intbl\cell\row\trowd\trgaph108\trrh489\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3
\clvertalc\clcbpat3\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx2713\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx6300\clvertalc\clcbpat3\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx8640\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx10080\pard\intbl\qr Course date*\cell\pard\intbl\cell\pard\intbl\qr Course fee attached\par
\pard\intbl\qc\b\i\fs18 Payable to RFD Ltd.\cell\pard\intbl\b0\i0\fs20\'a3\cell\row\trowd\trgaph108\trrh489\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3
\clvertalc\clcbpat3\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx2713\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx6300\clvertalc\clcbpat3\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx8640\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx10080\pard\intbl\qr Course venue*\cell\pard\intbl\cell\pard\intbl\qr VAT Registered?\cell\pard\intbl\qc Yes / No*\cell\row\pard\keepn\s6\fs24\par
\b Ethnicity*\par
\pard\b0\fs20 I would describe my ethnic origin as:\par
\trowd\trgaph108\trrh357\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3
\clvertalc\clbrdrr\brdrw15\brdrs \cellx2700\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx3060\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrr\brdrw15\brdrs \cellx6660\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx7020\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrr\brdrw15\brdrs \cellx9913\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx10260\pard\intbl\qr Asian British Bangladeshi\cell\cell Indian\cell\cell Other white\cell\pard\intbl\cell\row\trowd\trgaph108\trrh357\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3
\clvertalc\clbrdrr\brdrw15\brdrs \cellx2700\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx3060\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrr\brdrw15\brdrs \cellx6660\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx7020\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrr\brdrw15\brdrs \cellx9913\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx10260\pard\intbl\qr Asian British Indian\cell\cell Mixed White and Asian\cell\cell Pakistani\cell\pard\intbl\cell\row\trowd\trgaph108\trrh357\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3
\clvertalc\clbrdrr\brdrw15\brdrs \cellx2700\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx3060\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrr\brdrw15\brdrs \cellx6660\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx7020\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrr\brdrw15\brdrs \cellx9913\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx10260\pard\intbl\qr Asian British Pakistani\cell\cell Mixed White and Black African\cell\cell Prefer not to say\cell\pard\intbl\cell\row\trowd\trgaph108\trrh357\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3
\clvertalc\clbrdrr\brdrw15\brdrs \cellx2700\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx3060\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrr\brdrw15\brdrs \cellx6660\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx7020\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrr\brdrw15\brdrs \cellx9913\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx10260\pard\intbl\qr Bangladeshi\cell\cell Mixed White and Black Caribbean\cell\cell White British\cell\pard\intbl\cell\row\trowd\trgaph108\trrh357\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3
\clvertalc\clbrdrr\brdrw15\brdrs \cellx2700\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx3060\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrr\brdrw15\brdrs \cellx6660\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx7020\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrr\brdrw15\brdrs \cellx9913\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx10260\pard\intbl\qr Black African\cell\cell Other\cell\cell White European\cell\pard\intbl\cell\row\trowd\trgaph108\trrh357\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3
\clvertalc\clbrdrr\brdrw15\brdrs \cellx2700\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx3060\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrr\brdrw15\brdrs \cellx6660\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx7020\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrr\brdrw15\brdrs \cellx9913\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx10260\pard\intbl\qr Black British\cell\cell Other Asian\cell\cell White Irish\cell\pard\intbl\cell\row\trowd\trgaph108\trrh357\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3
\clvertalc\clbrdrr\brdrw15\brdrs \cellx2700\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx3060\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrr\brdrw15\brdrs \cellx6660\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx7020\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrr\brdrw15\brdrs \cellx9913\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx10260\pard\intbl\qr Black Caribbean\cell\cell Other Black\cell\cell White Non European\cell\pard\intbl\cell\row\trowd\trgaph108\trrh357\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3
\clvertalc\clbrdrr\brdrw15\brdrs \cellx2700\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx3060\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrr\brdrw15\brdrs \cellx6660\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx7020\clvertalc\clbrdrl\brdrw15\brdrs \cellx9913\clbrdrt\brdrw15\brdrs \cellx10260\pard\intbl\qr Chinese\cell\cell Other Mixed Background\cell\cell\cell\pard\intbl\cell\row\pard\f0\par
\pard\keepn\s6\f1\fs18 Disability*\par
\pard\par
\trowd\trgaph108\trrh413\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3
\clvertalc\clbrdrr\brdrw15\brdrs \cellx5040\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx8280\pard\intbl Do you consider yourself to have a disability?\cell\pard\intbl\qc Yes / No/ Prefer not to say *\cell\row\pard\fi720 If Yes, what is the nature of your disability (please check the appropriate box)?\par
\pard\par
\tab Hearing\tab\lang1033\f0\fs20\par
\lang2057\f1\fs18\tab Multiple\tab\tab Learning\tab\tab Visual\tab\tab Mobility\tab\par
\par
\tab Other\tab\tab Comment: \lang1033\enspace\enspace\enspace\enspace\enspace\lang2057\par
\par
\pard\keepn\s6 Additional Personal Details\par
\trowd\trgaph108\trrh596\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3
\clcbpat3\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx2533\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx6120\clcbpat3\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx7040\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx10080\pard\intbl\qr\par
Coaching Awards held / attended\par
\cell\pard\intbl\lang1033\f0\enspace\enspace\enspace\enspace\enspace\lang2057\f1\par
\par
\par
\cell Dates & Venues\cell\lang1033\f0\enspace\enspace\enspace\enspace\enspace\lang2057\f1\cell\row\trowd\trgaph108\trrh1134\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3
\clcbpat3\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx2533\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx6120\clcbpat3\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx7040\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx10080\pard\intbl\qr Coaching Seminars & CPD events attended\cell\pard\intbl\lang1033\f0\enspace\enspace\enspace\enspace\enspace\lang2057\f1\par
\par
\par
\par
\par
\par
\cell Dates & Venues\cell\lang1033\f0\enspace\enspace\enspace\enspace\enspace\lang2057\f1\cell\row\trowd\trgaph108\trrh823\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3
\clcbpat3\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx2533\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx10080\pard\intbl\qr Playing history and position(s)\cell\pard\intbl\cell\row\trowd\trgaph108\trrh668\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3
\clcbpat3\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx2533\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx10080\pard\intbl\qr My current rugby coaching activities are\cell\pard\intbl\cell\row\trowd\trgaph108\trrh823\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3
\clcbpat3\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx2533\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx10080\pard\intbl\qr Contact details (name & tel. no) in case of emergency on course \cell\pard\intbl\cell\row\pard\b\f0\fs20\par
\f1\fs18 Financial Implications for applicants not attending courses\par
\b0 If an applicant does not attend the course or who gives less than 48 hours notice the coach will receive no refund.  If an applicant gives between 2 and 14 days notice, the applicant can be relocated to another course providing they pay a \'a325 administration charge; there will be no refund.\par
If an applicant gives more than 2 weeks notice, they can be offered either relocation to another course at no charge, or a refund of 75% of the course cost.\par
\par
\b Nature of the Coaching Courses\par
\b0 Attendance on coaching courses will require some practical involvement to assist the coaching process. Please raise any issues that could affect your health with either the administrator, or your Coach Educator on arrival at the course. \par
\par
\b Data Protection\par
\pard\qj\b0 The RFU will use your personal data (including potentially sensitive data) [and that of your parents/guardians] for the purpose of your participation in rugby and for regulatory reasons and to send you information by post. To make your choice as to the categories of commercial information you would wish to receive, you should tick or leave blank the relevant box below.\par
\par
Subject to your election, the RFU may also use such personal data for the following purposes:-  \par
\par
\pard{\pntext\f3\'B7\tab}{\*\pn\pnlvlblt\pnf3\pnindent360{\pntxtb\'B7}}\fi-360\li360\qj\tx720 If you \ul\b do not\ulnone\b0  wish to receive, by electronic mail (including e-mail, SMS or image messages etc) information about tickets, special offers, opportunities, products and services available from RFU companies or RFU subsidiaries, tick here \par
\pard\qr\par
\pard{\pntext\f3\'B7\tab}{\*\pn\pnlvlblt\pnf3\pnindent360{\pntxtb\'B7}}\fi-360\li360\qj\tx720 If you \ul\b do not\ulnone\b0  wish to receive, by electronic mail (including e-mail, SMS or image messages etc) information about products and services available from current RFU sponsors, tick here\tab\tab\tab\tab\tab\tab\par
\pard\qr\par
\pard{\pntext\f3\'B7\tab}{\*\pn\pnlvlblt\pnf3\pnindent360{\pntxtb\'B7}}\fi-360\li360\qj\tx720 If you \ul\b do\ulnone\b0  wish to receive, by electronic mail (including e-mail, SMS or image messages etc) information about products and services available from any subsidiary or associated company of any RFU sponsor, tick here\tab\tab\tab\par
\pard\li360\qr\par
\pard [NB: An opportunity for the recipient to unsubscribe from receiving future e-mails of the nature to the one sent will always be included.]\par
\pard\keepn\s6\par
Declaration*\par
\trowd\trgaph108\trrh425\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3
\clvertalc\clcbpat3\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx7753\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx10080\pard\intbl\qr I have completed a Criminal Records Bureau (CRB) Check \cell\pard\intbl\qc Yes / No*\cell\row\trowd\trgaph108\trrh425\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3
\clvertalc\clcbpat3\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx7753\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx10080\pard\intbl\qr CRB Reference No:\cell\pard\intbl\qc\cell\row\trowd\trgaph108\trrh548\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3
\clvertalc\clcbpat3\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx1813\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx6840\clvertalc\clcbpat3\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx7753\clvertalc\clbrdrl\brdrw15\brdrs\clbrdrt\brdrw15\brdrs\clbrdrr\brdrw15\brdrs\clbrdrb\brdrw15\brdrs \cellx10080\pard\intbl\qr Signature\cell\cell\pard\intbl\qc Date\cell\cell\row\pard\f0\fs20\par
}