Application Form

1. Personal details

Title
—Please choose an option—MrMrsMsMissOther

Sex
FemaleMaleOtherPrefer not to say

Forenames*

Family Name/Surname*

Date of birth*

Address*

Postcode*

Borough/Area*

Home Telephone Number

Mobile Number*

Email*

Preferred method of contact:
TelephoneEmailPost

Please note that you may be contacted for information, advice and guidance regarding the course you inquire about, as well as other course opportunities and learner events.

2. Residency

What type of visa / residence permit do you currently hold?

Visa expiry date

When did you come to the UK?

Please note: if you are a family member of someone who has been resident within the EEA for the last three years, and you have not been ordinarily resident in the EEA for the last 3 years you can still be eligible if you are an EU or EEA citizen.

Are you a Refugee?
YesNo

Are you an Asylum Seeker?
YesNo

How would you describe your ethnic group or background?
English/Welsh/Scottish/Northern Irish/BritishIrishGypsy or TravellerAny other white backgroundWhite and Black CaribbeanWhite and Black AfricanWhite and AsianAny Other Mixed/Multiple Ethnic BackgroundIndianPakistaniBangladeshiChineseAny other Asian backgroundAfricanCaribbeanAny other Black/African/Caribbean backgroundArabAny other ethnic group

3. Employment status

Tick all boxes that apply to you:
In full-time educationIn full-time paid employmentIn part-time paid employmentSelf-employedUnemployed (less than 6 months)Unemployed (between 6 and 36 months)Unemployed (more than 36 months)

Are you in receipt of any of the following? Tick all boxes that apply to you:
Job Seeker's Allowance (JSA)Universal CreditEmployment Support Allowance (all categories)Other state benefits (disregarding UC payments and other benefits)Unwaged dependent of someone receiving one of the aboveOther (please specify below)

Other

4. Health conditions, learning difficulty and disabilities

Do you consider yourself to have a health condition, disability, or learning difficulty?
YesNo

If yes, please tick all that apply:
Visual impairmentHearing impairmentDisability affecting mobilityProfound complex disabilitiesSocial and emotional difficultiesMental health difficultySevere learning difficultyDyslexiaDyscalculiaAutism Spectrum DisorderAsperger’s SyndromeTemporary disability after illness (for example post viral) or accidentSpeech Language and Communication NeedsOther physical disabilityOther specific learning difficulty (e.g. Dyspraxia)Other medical condition (e.g. epilepsy, asthma, diabetes)Other learning difficultyOther disabilityPrefer not to say

5. Prior attainment

Which level of qualifications have you achieved prior to this enrolment (any subject)? Tick all that apply to you:
Entry levelLevel 1 (Secondary School)Level 2 (GCSE equivalent)Full Level 2 (equivalent of 5 or more GCSEs at Grades A–C or 4–9 or an NVQ Level 2)Level 3 (A levels equivalent)Full Level 3 (equivalent to 2 or more A levels or an NVQ Level 3)Level 4 (Advanced Learning)Level 5 (Foundation Degree)Level 6 (Bachelor’s Degree)Level 7 (Master’s Degree) and aboveOther qualification, level unknownNo qualifications

6. Evidence of ID and eligibility to reside in the UK

The valid ID you can produce:
British PassportUK Driver’s LicenceEEA PassportFamily member's British/EEA PassportEEA ID cardEEA Driver’s LicenceBirth Certificate with official ID

Do you have a National Insurance Number:
YesNo

7. Courses you are interested in

Course 1
—Please choose an option—Functional Skills Maths – E1Functional Skills Maths – E2Functional Skills Maths – E3Functional Skills Maths – L1Functional Skills Maths – L2Functional Skills English – E1Functional Skills English – E2Functional Skills English – E3Functional Skills English – L1Functional Skills English – L3Essential Digital Skills – E3Essential Digital Skills – L1English Speaker of Other Language (ESOL) for Job – E1English Speaker of Other Language (ESOL) for Job – E2English Speaker of Other Language (ESOL) for Job – E3English Speaker of Other Language (ESOL) for Job – L1English Speaker of Other Language (ESOL) for Job – L2Adult Care – Level 2Adult Care – Level 3Computer Engineering – Level 3Programming and Coding – Level 2Programming and Coding – Level 3Green Skills – Level 2Artificial Intelligence

Course 2
—Please choose an option—Functional Skills Maths – E1Functional Skills Maths – E2Functional Skills Maths – E3Functional Skills Maths – L1Functional Skills Maths – L2Functional Skills English – E1Functional Skills English – E2Functional Skills English – E3Functional Skills English – L1Functional Skills English – L3Essential Digital Skills – E3Essential Digital Skills – L1English Speaker of Other Language (ESOL) for Job – E1English Speaker of Other Language (ESOL) for Job – E2English Speaker of Other Language (ESOL) for Job – E3English Speaker of Other Language (ESOL) for Job – L1English Speaker of Other Language (ESOL) for Job – L2Adult Care – Level 2Adult Care – Level 3Computer Engineering – Level 3Programming and Coding – Level 2Programming and Coding – Level 3Green Skills – Level 2Artificial Intelligence

Course 3
—Please choose an option—Functional Skills Maths – E1Functional Skills Maths – E2Functional Skills Maths – E3Functional Skills Maths – L1Functional Skills Maths – L2Functional Skills English – E1Functional Skills English – E2Functional Skills English – E3Functional Skills English – L1Functional Skills English – L3Essential Digital Skills – E3Essential Digital Skills – L1English Speaker of Other Language (ESOL) for Job – E1English Speaker of Other Language (ESOL) for Job – E2English Speaker of Other Language (ESOL) for Job – E3English Speaker of Other Language (ESOL) for Job – L1English Speaker of Other Language (ESOL) for Job – L2Adult Care – Level 2Adult Care – Level 3Computer Engineering – Level 3Programming and Coding – Level 2Programming and Coding – Level 3Green Skills – Level 2Artificial Intelligence

8. Data protection

This privacy notice is issued by the Education and Skills Funding Agency (ESFA) on behalf of the Secretary of State for the Department of Education (DfE) to inform learners about the Individualised Learner Record (ILR) and how their personal information is used in the ILR. Your personal information is used by the DfE to exercise our functions under article 6(1)(e) of the UK GDPR and to meet our statutory responsibilities including under the Apprenticeships Skills Children and Learning Act 2009. Our lawful basis for using your special category personal data is covered under Substantial Public Interest based in law (Article 9(2)(g)) of GDPR legislation. This processing is under Section 54 of the Further and Higher Education Act (1992).

We collect data about learners and the learning undertaken. Publicly funded colleges training organisations local authorities and employers (FE providers) must collect and return the data to the ESFA each year under the terms of a funding agreement contract or grant agreement. It helps ensure that public money distributed through the ESFA is being spent in line with government targets. It is also used for education training employment and well-being purposes including research.

For more information about the ILR and the data collected please see the ILR specification at ILR specification.

For more information about how your personal data is used and your individual rights please see the DfE Personal Information Charter at Personal Information Charter and the DfE Privacy Notice at DfE Privacy Notice.

If you would like to get in touch with us or request a copy of the personal information DfE holds about you, you can contact the DfE in the following ways:

• Using our online contact form

• By telephoning the DfE Helpline on 0370 000 2288

• Or in writing to: Data Protection Officer, Department for Education (B2.28) 7 & 8 Wellington Place, Wellington Street, Leeds, LS1 4AW

If you are unhappy with how we have used your personal data you can complain to the Information Commissioner’s Office (ICO) at:

Wycliffe House, Water Lane, Wilmslow, Cheshire, SK9 5AF. You can also call their helpline on 0303 123 1113 or visit https://www.ico.org.uk

9. Declaration

I declare that all the information I have provided is accurate and that I have read and understood the statement relating to Data Protection and agree to provide proof of my eligibility status. I confirm that the information given on this application form is complete and accurate.

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