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Section 1: Personal details

Title
Surname (Family Name)
First Forename
Date of Birth
Gender
Contact Number (Home Telephone)
Mobile
E-mail address
Email (confirm)
National Insurance Number

Note: If you are on benefits, providing a National Insurance number is mandatory.

Section 1 (continued): Your address

Please enter your current address:

Country
Postcode
I don't know the postcode
Enter address manually / My address is not listed

Section 2: Next of kin / emergency contacts

For 16–18 year olds and learners with a Learning Difficulty or Disability, providing at least one emergency contact is mandatory.
Emergency Contact Name
Emergency Contact Relationship
Emergency Contact Phone number

Section 3: Residency

Country of birth
What country have you lived in during the last 3 years?
Ethnic Group
Will you have lived continuously in the UK for more than 3 years on the first day of your course?

Section 4: Education

What is your highest level of qualification?
Help me pick the right level
Level Academic qualification equivalent
Entry LevelFirst Certificate, GCSE grades D–G (1–3), Level 1 Award/Certificate/Diploma, ESOL, Functional Skills, NVQ Level 1, Music grades 1–3
Level 1GCSE grades 1–3 / F–D, First Certificate, Level 1 Award/Certificate/Diploma, Functional Skills Level 1
Level 2Vocational and technical qualifications at level 2, Functional Skills Level 2, ESOL
Full Level 25+ GCSEs grades A*–C (or grade 4+), 1 A Level, NVQ Level 2, GNVQ Intermediate
Level 3Vocational and technical qualifications at level 3, Core Maths, Technical qualifications
Full Level 32+ A Levels, QCF Diploma Level 3, QAA Access to HE, GNVQ Advanced, NVQ Level 3
Level 4Certificate of Higher Education, Higher Apprenticeship, HNC
Level 5Diploma of Higher Education, Foundation Degree, HND
Level 6Degree Apprenticeship, Honours Degree
Level 7Masters Degree, PgDip
Level 8Doctorate / PhD

Section 5: Disabilities, medical conditions and learning support

Do you have any disabilities or learning difficulties?
Primary Disability / Learning Difficulty
Secondary Disability / Learning Difficulty
Please describe any further disabilities and how they impact your learning:
Disability / Learning Difficulty Notes

Section 7: Employment

Employment Status
Are you self-employed?
How many hours per week? (if employed)
Length of unemployment (if unemployed)
Which benefit do you receive? (select "No benefits" if none apply)

Privacy and data sharing

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). It is to inform learners how their personal information will be used by the DfE, the ESFA and any successor bodies. Your personal information is used by the DfE to exercise its functions and to meet its statutory responsibilities, including under the Apprenticeships, Skills, Children and Learning Act 2009, and to create and maintain a unique learner number (ULN) and a personal learning record (PLR).

Southend Adult Community College additionally collects personal data about you as a learner for academic and administrative purposes. We may also contact you about courses or learning opportunities that may be of interest to you. Further information: Privacy Notice.

Confirmation