7/31/2019 EHA Candidate Application Form
1/2
EHACAD Form 6
E n g l a n d H a n d b a l l A s s o c i a t i o nC o u r s e A
d m i n i s t r a t i o n i n c o n j u n c t i o nw i t h S p o r
t S t r u c t u r e s
EHA Candidate Application Form
Course Start Date (DD/MM/YY) Course venue About You
Full Name Address
Postcode Contact number (home) Contact number (mobile) Email
address Date of birth (DD/MM/YY) Emergency Contact Name
andNumber
How did you hear about thisqualification
Please tick the appropriate box to indicate your gender: Male
Female
Ethnic origin(Please tick the appropriate box to indicate your
cultural background):White - British Asian or Asian British -
Bangladeshi
White Irish Any other Asian background
Any other white background Black or Black British -
Caribbean
Mixed - White and Black Caribbean Black or Black British -
African
Mixed - White and Black African Any other black background
Mixed - White and Asian Chinese
Any other mixed background Prefer not to state
Asian or Asian British - IndianAny other (please write in)
Asian or Asian British - Pakistani
Sport Structures, EHA Course Administration, Concorde House,
Trinity Park, Solihull,Birmingham, B37 7UQ
7/31/2019 EHA Candidate Application Form
2/2
EHACAD Form 6
E n g l a n d H a n d b a l l A s s o c i a t i o nC o u r s e A
d m i n i s t r a t i o n i n c o n j u n c t i o nw i t h S p o r
t S t r u c t u r e s
The Disability Discrimination Act 1995 defines a disabled person
as anyone with a physical or
mental impairment that has a substantial and long-term adverse
effect upon his/her ability to carryout normal day-to-day
activities. Do you consider yourself to have a disability?
Yes No
If yes, what is the nature of your disability? Please tick the
appropriate box
Sensory impairment (including visual and hearing) Learning
disability
Physical impairment Multiple impairments
Mental health difficulty (e.g. severe depression, bipolar) Do
not wish to answer
Do you have any special needs of requirements that the coach
should be aware of before thecourse?
Yes No
If yes, please specify:
Please indicate if you would like to receive our monthly coach
and volunteer education newsletter:
Yes No
Payment method
Please state how you will bepaying for the qualification (ifnot
applicable, please stateN.A)
Please return this application form via email
[email protected] .Alternatively our
postal address is;
Sport Structures, EHA Course Administration, Concorde House,
Trinity ParkSolihull, Birmingham, B37 7UQ
(Please return booking form 7 days priorto the
qualification)
Thank you for your cooperation
Terms and Conditions
If you cancel within 7 days or fail to attend the course without
good reason ( at the sole discretion of
Sport Structures), the full fee will apply. If you cancel within
14 days of the qualification then 50% of cost will be returned to
you
Once payment and the application form is returned, confirmation
of course details will be sent 7days prior to the course.
If Sport Structures cancels the course, you will automatically
be booked onto the next availablecourse date. If attendance is not
possible, then a refund will be given.
The information provided by the applicant will be stored on the
Sport Structures CIC Database andheld in accordance with the Data
Protecting Act 1998.
Sport Structures, EHA Course Administration, Concorde House,
Trinity Park, Solihull,Birmingham, B37 7UQ
mailto:[email protected]:[email protected]:[email protected]
