Full name*:
*
Contact number
*
Date of Birth*:
*
Gender:
Male
Female
Email:
*
Correspondence address: (inc. post code)
*
Emergency contact: (name & mobile/landline)
*
Do you have a passport?
*
yes
no
Nationality:
Passport number:
Expiry date:
Ethnicity:
*
White: British
White: Irish
White: Other
Black / Black British: Caribbean
Black / Black British: African
Black / Black British: Other
Mixed: White & Black Caribbean
Mixed: White & Black African
Mixed: White & Asian
Mixed: Other
Chinese / Other: Other
Chinese / Other: Chinese
Asian / Asian British: Indian
Asian / Asian British: Pakistani
Asian / Asian British: Bangladeshi
Asian / Asian British: Other
Gypsy / Romany / Irish Travelle
Do not wish to disclose
Accommodation type:
Council / Housing Association
Shared house with suppor
Bail / probation hostel
Sofa surfing
Sleeping rough
Private rented
Bed & breakfast
Night shelter
Hostel
Refuge
Squat
Other
Service where you heard about this opportunity:
How long were you/have you been homeless?
*
Educational achievements:
None / Pre-entry level
Level 2 (GCSE (A* - C, NVQ2)
Level 5 (HNCs, HNDs)
Entry level (Maths and English)
Level 3 (A-Levels, NVQ3)
Level 6 (Bachelor’s degree)
Level 1 (GCSE D-G, NVQ1)
Level 4 (NVQ4)
Level 7/8 (MA/Doctoral degree, NVQ5)
Employment status:
Full time
Part time
Self-employed
Volunteering
Unemployed
What do you think has been your greatest achievement?
Can you give an example of a challenge (large or small) you overcame, and how you overcame it?
What three characteristics do you see as important for a good leader to have?
Can you give an example of where you have shown one of these characteristics?
Why do you want to attend a Homeless FA Training Centre?
What would you like to gain from the Training Centre?
Are you currently playing football?
Yes
No
If yes, where do you play football? (project/club name)
Is this project/club linked to your accommodation?
Yes
No
Training Centre applying for: (APPLICATIONS WILL ONLY BE CONSIDERED FOR YOUR LOCAL TRAINING CENTRE)
*
Arsenal
Brighton and Hove Albion
Bristol City
Derby County
Hull City
Manchester United
Norwich City
Sunderland
West Bromwich Albion
Are you currently on any medication?
Yes
No
Please provide information if yes:
Do you have a disability?
Yes
No
Please provide information if yes:
Please list any dietary requirements:
Please list any allergies:
Please list any access issues:
Sizing Information:
S
M
L
XL
XXL
References
We require two references in support of your application. It is necessary that these people know you well and can support you if your application is successful. By completing this application you understand and give permission for the Homeless FA to contact these referees and discuss how the Homeless FA can best ensure your support and safety during the Training Centres. Our decision is not based on this reference but will give a better understanding of how you can best be supported by and benefit from this programme. Suggested referees: support worker, football coach, drug/alcohol treatment worker, probation officer, employer. One referee must be a key worker or similar.
Referee 1
Full name:
*
Email:
*
Address:
*
Contact number:
*
Relationship:
*
Referee 2
Full name:
*
Email:
*
Address:
*
Contact number:
*
Relationship:
*
