Lottery Pilot Enrolment and Qualification Form for 'Awakening Neurodiversity' Level 5 Pilot Supported by Pilot Registration: Awakening Neurodiversity West Yorkshire Community Empowerment Initiative • Level 5 NeuroCoach Pilot Pilot Recruitment & Programme Commitment Window Opens25th May 2026 Window Closes31st July 2026 Commitment: Successful applicants must commit to the full 18-week supported learning programme. Section 1: Personal Identity & Residency Full Name * Full Name First Name First Name Last Name Last Name Primary Email Address * Postcode * Used to verify West Yorkshire residency for the Huddersfield hub. Section 2: Educational Eligibility & Professional Status English Language Qualification * GCSE English (Grade C/4 or above)Functional Skills Level 2Level 2 NVQInternational EquivalentOther Please use this section to detail your current professional roles and confirm your educational background. To ensure you can fully engage with the course materials and frameworks, all applicants are required to hold a minimum of a Level 2 qualification in English Language or a recognised equivalent. You must upload a clear copy of your certificate or formal proof of your qualification below. Please be aware that your application cannot be processed and the form submission will automatically fail if you do not attach the required documentation. Upload Proof of Level 2 English (or equivalent) All file formats are accepted * Drop a file here or click to upload Choose File Maximum file size: 10MB Section 3: Equality, Diversity, and Inclusion (EDI) Monitoring How do you identify? (Neuro-Identity) * Autistic ADHD Dyslexic AuDHD Self-Identified Neurodivergent Prefer not to say Ethnic Heritage * Asian or Asian British (Indian)Asian or Asian British (Pakistani)Asian or Asian British (Bangladeshi)Asian or Asian British (Chinese)Asian or Asian British (Any other Asian background)Black, Black British, Caribbean or African (Caribbean)Black, Black British, Caribbean or African (African)Black, Black British, Caribbean or African (Any other Black background)Mixed or multiple ethnic groups (White and Black Caribbean)Mixed or multiple ethnic groups (White and Black African)Mixed or multiple ethnic groups (White and Asian)Mixed or multiple ethnic groups (Any other Mixed background)White (English, Welsh, Scottish, Northern Irish or British)White (Irish)White (Gypsy or Irish Traveller)White (Roma)White (Any other White background)Other ethnic group (Arab)Other ethnic group (Any other ethnic group)Prefer not to say Personal Statement * Please use this space to explain your motivation for joining the NeuroCoach programme. You are not expected to have prior knowledge of neurodiversity or professional coaching to apply; we are simply looking for a genuine desire to support others. Crucially, we want to hear your authentic voice. Please write this statement using your own words and reflections, ensuring you do not use Artificial Intelligence to generate your response. We are interested in your personal thoughts, your lived experiences, and your unique perspective. In your statement, share why you believe in focusing on personal strengths and natural capabilities. You might describe your readiness to champion inclusive environments, your willingness to embrace new ways of thinking, or your passion for guiding people through positive change and personal awakening. Tell us how you hope to empower others to authentically own their journey. Professional Accountability & Ethical Consent * signature keyboard Clear Data Processing Consent * Yes No "I consent to DECKACY processing my qualification documents and EDI data for anonymised National Lottery reporting." Submit If you are human, leave this field blank.
