ADSHE Institutional members confirmation form
Institutional membership is open to Higher Educational Institutes and Further Education Colleges and covers all employees or sessional staff who meet the Individual Membership criteria.

It entitles all members to the benefits of full membership: [new weblink here]

1-5 members £225.00

6-10 members £325.00

11-15 members £450.00

15-20 members £600.00

Additional members (over 20) £45.00 per member

Institutional membership covers the current academic year from the beginning of September to the end of August.

ALL Institutional members must use their institutional email address for access to JISCMAIL.

To apply, the lead member should:

a) complete this institutional members confirmation form supplying the names and contact email of all your specialist tutors and submit the form with payment. This form only needs to be completed once and thereafter it is possible to renew on an annual basis. The administrator will contact you each year regarding your renewal.

AND

b) ensure that all named tutors complete the full membership process for their category: http://adshe.org.uk/membership/. No one will be accepted as a member until their individual membership process is completed.

Section A: Institution Information
1. Institution Name & Address
Your answer
2. How many staff members in your institutional are eligible to become ADSHE Members?
(please state number)
Your answer
Section B. Designated full members:
You only need to complete the name boxes for the number of tutors you would like to register for institutional membership e.g. if you only have 5 tutors complete only box 1-5

Please present your members details in the following format:

email full name

e.g.

joe.green@llu.ac.uk Joe Green

Please note only institutional email addresses are permitted for institutional members.

THIS FORM ONLY NEEDS TO BE SUBMITTED THE FIRST TIME YOU APPLY AS AN INSTITUTION. ANY CHANGES CAN THEN BE MADE BY EMAILING THE DETAILS TO ADSHE ADMIN.

Name 1. & email (This person will be regarded as the named member for the HEI and must complete section C)
email first e.g. joe.green@llu.ac.uk Joe Green
Your answer
Name 2. & email
email first e.g. joe.green@llu.ac.uk Joe Green
Your answer
Name 3. & email
email first e.g. joe.green@llu.ac.uk Joe Green
Your answer
Name 4. & email
email first e.g. joe.green@llu.ac.uk Joe Green
Your answer
Name 5. & email
email first e.g. joe.green@llu.ac.uk Joe Green
Your answer
Name 6. & email
email first e.g. joe.green@llu.ac.uk Joe Green
Your answer
Name 7. & email
email first e.g. joe.green@llu.ac.uk Joe Green
Your answer
Name 8. & email
email first e.g. joe.green@llu.ac.uk Joe Green
Your answer
Name 9. & email
email first e.g. joe.green@llu.ac.uk Joe Green
Your answer
Name 10. & email
email first e.g. joe.green@llu.ac.uk Joe Green
Your answer
Name 11. & email
email first e.g. joe.green@llu.ac.uk Joe Green
Your answer
Name 12. & email
email first e.g. joe.green@llu.ac.uk Joe Green
Your answer
Name 13. & email
email first e.g. joe.green@llu.ac.uk Joe Green
Your answer
Name 14. & email
email first e.g. joe.green@llu.ac.uk Joe Green
Your answer
Name 15. & email
email first e.g. joe.green@llu.ac.uk Joe Green
Your answer
Name 16. & email
email first e.g. joe.green@llu.ac.uk Joe Green
Your answer
Name 17. & email
email first e.g. joe.green@llu.ac.uk Joe Green
Your answer
Name 18. & email
email first e.g. joe.green@llu.ac.uk Joe Green
Your answer
Name 19. & email
email first e.g. joe.green@llu.ac.uk Joe Green
Your answer
Name 20. & email
email first e.g. joe.green@llu.ac.uk Joe Green
Your answer
Additional Names Over 20 (please list all additional names)
email first e.g. joe.green@llu.ac.uk Joe Green
Your answer
Section C. Role of Named Member
It is a condition of Institutional Membership that a named member takes responsibility:

• to ensure that all dyslexia specialists employed by the HEI are made aware of this membership opportunity

• to ensure that all members listed above are aware that it is their personal responsibility to complete and submit a full membership form, and scan and send their evidence the first time they join.

It is not the named member’s responsibility to return these forms. Members will not be added to JISCMAIL until this is completed.

• to update the ADSHE Administrator annually at point of renewal or when changes in staff occur to ensure that new staff are added to the list or staff who have left or retired are removed

Full Name of Named Member
First name Surname
Your answer
Contact telephone
Your answer
Contact email
Your answer
Section D: Payment Information
1. Indicate the category of membership for which you are applying
2. Complete as applicable
For invoice payment: Email address/ address and Purchase Order Number (if necessary) to send invoice
Your answer
Where did you hear about ADSHE?
Required
Submit
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