Application for Partnership

CONFIDENTIAL

Name of Institution: 
Address: 
Contact Details:

GENERAL DETAILS OF THE INSTITUTION

1.	Mission Statement or brief description of the Institution’s main functions and objectives

2.	Date of Foundation

3.	Methods of Funding

4.	Private or Public Sector

5.	Size of Institution

6.	Academic and Management Structure
7.	Links with other organisations
8.	Development Plans, if any

FACILITIES AND RESOURCES
1.	Library
2.	Laboratory
3.	IT
4.	Classrooms
5.	Staff
•	Numbers
•	Balance of full-time and part-time
•	Staff development policy
•	Technician and Administrative support (to include facilities for the electronic collection and transmission of student data)
•	Budget for sustaining these facilitie

ACADEMIC BACKGROUND

1.	Number of Courses

2.	Level of Courses

3.	Courses taught by Blended Learning

4.	Number of students
•	full-time
•	part-time
•	qualifications on entry
		
5.	Relationships with other institutions/bodies in locality
•	Q.A. Procedures
•	Committee Structure

JUSTIFICATION OF PROPOSAL

Please provide a brief statement underlining the rationale for the partnership proposal.

ANY FURTHER INFORMATION/COMMENTS

PLEASE NOTE: It is the responsibility of the institution seeking validation to disclose any material facts that you are aware of regarding any legal issues or publicity related issues which have arisen at your institution.

Name:______________________________

Title:  ______________________________   

Signed: _____________________________		

Date:  ______________________________