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People and Skills Enrolment Form and Learning Agreement

UK Shared Prosperity Fund – People and Skills Enrolment Form and Learning Agreement

The information provided in this form will be used to process your enrolment, deliver the course and arrange funding for your course through the UK Shared Prosperity Fund. In addition, this information will be used to monitor service and contract. Please note, the data we gather will not be shared outside of people working with us. For more details of our data privacy notice please go to https://www.learningandskillsacademy.org.uk/privacy

People and Skills Enrolment Form and Learning Agreement

Personal Details

1. Personal Details

Title:

First name:

Surname:

Gender:

Address:

Postcode:

Home phone number:

Mobile phone number:

Date of Birth:

National Insurance number:

Opt-In

I confirm I am 16 or over

Email Address

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The Managing Authority (or agents acting on its behalf) may contact you in order for them to carry out research and evaluation to inform the effectiveness of training.

You can agree to be contacted for other purposes by ticking any of the following boxes:

About courses or learning

For surveys and research

If you indicated above that you are happy to be contacted, please tell us below how you would like to be contacted:

By post

By phone

By email

By text message

Equality and Diversity

2. Equality and Diversity

Please tick if you have any of the following:

Visual impairment

Hearing impairment

Disability affecting mobility

Other physical disability

Profound complex disabilities

Moderate learning difficulty

Severe learning difficulty

Other specific learning difficulty

Asperger's syndrome

Dyscalculia

Autism spectrum disorder

Dyslexia

Mental Health difficulty (e.g. depression, anxiety, stress)

Temporary disability illness or accident

Other medical condition (e.g. epilepsy, asthma, diabetes)

Other disability (please specify in section 3)

Learner Support

3. Learner Support

If you require additional personal support to participate in your course, please notify your tutor and outline below what support you may need:

Are you a care leaver or ever been in care?:

Ethnicity

4. Ethnicity

Please tick your ethnicity:

White - British

White - Irish

White - Other

Mixed - White Black Caribbean

Mixed - White Black African

Mixed - White Asian

Mixed - Other

Indian

Pakistani

Bangladeshi

Chinese

Asian

Black African / British

Black Caribbean / British

Black Other

Any Other

Other (if not stated above):

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5. Residential Status and Eligibility Self-Declaration

A UK national or other person with right of abode and lived in the EEA (including the UK) for at least the last 3 years

A UK national or other person with right of abode and lived in the EEA (including the UK) for at least the last 3 years

An EEA national in the UK with either pre-settled or settled status under the EU Settlement Scheme and lived in the EEA (including the UK) for at least the last 3 years

An EEA national in the UK with either pre-settled or settled status under the EU Settlement Scheme & lived in the EEA (incl. the UK) for at least the last 3 years

If neither of the above applies, please describe your residential/immigration status:

Existing Qualifications

6. Existing Qualifications

Do you have Math’s GCSE level 2 at Grade C (4) or above?

Do you have English GCSE level 2 at Grade C (4) or above?

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If you are 19+ and do not have a GCSE A-C in math or English, you are entitled to our MULTIPLY programme and/or free Functional Skills courses run by the Adult Learning Service. For more information, please e-mail englishandmaths@northnorthants.gov.uk or contact us at 01604 367119.

Employment Status

7. Employment Status

Please select one employment status:

Household Situation

8. Household Situation

Please select statements that apply:

No household member is in employment and the household includes one or more dependent children

No household member is in employment and the household does not include any dependent children

I live in a single adult household with dependent children

None of the above apply

I confirm that I wish to withhold this information

Additional Support

9. Additional Support

Adult Learning work in partnership with The National Careers Service to promote and support your choices about the next stage of your education, employment, self-employment or training. By ticking this box you confirm you would like to be contacted by our team who will let you know how to access impartial careers advice and guidance with qualified careers advisors.

Adult Learning work in partnership with The National Careers Service to promote and support your choices about the next stage of your education, employment, self-employment or training. By ticking this box you confirm you would like to be contacted by our team who will let you know how to access impartial careers advice and guidance with qualified careers advisors.

Learner Declaration

10. Learner Declaration

Free Text

• I agree to comply with all health and safety requirements and that the UKSPF Delivery Partner reserves the right to deny access if I fail to comply.

• I understand and accept that the UKSPF Delivery Partner may have to change, close or combine classes if a class is not available.

• I understand that the UKSPF Delivery Partner has received Grant funding to offer this course, and therefore is contractually required to share this information to be enrolled on the course.

• I confirm I have read and understand the privacy notice

I confirm that the details on this form are correct, and I will inform the UKSPF Delivery Partner if any details change.

Learner Confirmation:

Date:

Privacy Notice

11. Privacy Notice

Free Text

Privacy Notice including information about your rights, further information about use of and access to your personal data, details of organisations with whom we regularly share data, information about how long we retain your data, and how to change your consent to being contacted, please visit the Northamptonshire Adult Learning Service - privacy notice: www.northnorthants.gov.uk/service-privacy-notices/adult-learning-privacy-notice

If you have concerns about our use of your personal information, you can make a complaint to the Data Protection Officer at: Ministerial and Public Communications Division, Department for Education, Piccadilly Gate, Store Street, Manchester, M1 2WD.

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Tony Knaggs, Managing Director

tonyknaggs@learningandskillsacademy.org.uk

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