Support Providers Application

Support Providers - Helping students achieve their academic and personal goals

Freelance self-employed Support Providers play a vital part in enabling students with additional needs to participate fully in academic life.

Application for Support Provider roles

If you wish to be added to list of freelance support providers maintained by the Register of Support Providers at Ulster University, the first step is the completion of an application form.

The application form must demonstrate clearly how you meet the criteria for the role you are interested in, as outlined in these guidelines (http://www.ulster.ac.uk/supportregister/Student/All%20Roles.pdf ).

Helpful Links Can be Found Here - http://www.ulster.ac.uk/supportregister/

Support Provider Application

Academic Mental Health Mentor
ASD Mentor
AT trainer
Audio Typist
Campus Assistant (General)
Campus Assistant with Note taking
Dyslexia Coach

General Reader
Library Assistant
Mathematics and Statistics Coach
Note Taker

Proof Reader
Reader
Scribe
Study Skills Coach
Typist

Indicate the role/s you wish to apply for:
**

Indicate which campuses you are available to provide support on: Belfast Coleraine Derry~Londonderry

Campus preferred to be interviewed on should your initial application be successful:

Personal details

National Insurance Number

First Name

Last Name

Gender

Date of Birth

Street 1

County

Street 2

ZIP/Postal Code

Street 3

Country/Region

City

Home Phone

Personal Email

Mobile Phone

Are there any specific requirements you have that need to be put in place for you to attend interview or to participate in the Register of Support Providers?

NoYes

Disability Requirements

Please provide details of higher education and other relevant education or training courses:

Institution attended: Qualification: subject: Grade Date:

Beginning with your current or most recent employment, provide details of work experience, including paid and voluntary work:

Employer: Job Title: Main duties & responsibilities: Dates:

Please use this space to detail any additional skills, knowledge and experience, relevant to the role/s for which you have applied.

Declaration

Have you ever been liable for any civil wrongs?

NoYes

If Yes, please give details:

Have you a criminal record?

NoYes

If Yes, please give details:

Please list 2 referees, one of whom should have knowledge of your recent work. (Please indicate if you do not wish a reference to be taken up before you are interviewed)

Referee 1

(Name: Email: Occupation: Address:)

Referee 2

(Name: Email: Occupation: Address:)

I confirm that to the best of my knowledge the information given on this form is correct.

I Confirm the details given are Accurate