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Enrolment form - Section 1: Personal Details (1 of 2)


Title
Surname (Family Name)

First Forename

Date of Birth

Gender


Contact Number (Home Telephone)
Mobile

E-mail address

Email (Please enter again)

National Insurance Number


Section 1: Personal Details (2 of 2)

Please enter your current Address:

Address1
Address2
Address3
Address4

Postcode


Section 2: Next of Kin / Emergency Contacts

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 Level first certificate GCSE - grades 3, 2, 1 or grades D, E, F, G level 1 award level 1 certificate level 1 diploma level 1 ESOL level 1 essential skills level 1 functional skills level 1 national vocational qualification (NVQ) music grades 1, 2 and 3
Level 1 For example, GCSE grades 1-3/F-D, First certificate, Level 1 Award/Certificate/Diploma, Functional Skill Level 1
Level 2 Vocational and technical qualifications at level 2 Functional skills at level 2 ESOL (skills for life) Technical Awards in the Key Stage 4 Performance Tables
Full Level 2 GCSE/O Level (5 or more GCSEs grades A*-C), GCSE (9-1) (5 or more GCSEs grade 4 or above), 2 or 3 AS Levels (for AS qualifications regulated before 1 September 2015), CSE Grade 1 (5 or more), 1 A Level, Higher 14-19 Diploma, QCF Diploma level 2, QCF Certificate level 2 at 13 or 14 credits undertaken before 2014 to 2015, Level 2 Principal Learning, NVQ level 2, GNVQ Intermediate,
Level 3 Vocational and technical qualifications at level 3 Core maths Technical qualifications (part of T levels) Components of international baccalaureate
Full Level 3 A Levels (2 or more advanced level passes), 4 or more AS Levels (for AS qualifications regulated before 1 September 2015), QCF Diploma Level 3, QAA Access to HE, Advanced 14-19 Diploma, GNVQ Advanced, NVQ level 3, AVCE double award, Tech Levels which are in the 16-19 Performance Tables, Applied Generals which are in the 16-19 Performance Tables (from 1 August 2015), QCF Certificate at Level 3 which is 30 to 36 credits
Level 4 For example, Certificate of Higher Education, Higher Apprenticeship, HNC
Level 5 For example, Diploma of Higher Education, Foundation Degree, HND
Level 6 For example, Degree Apprenticeship, Honours Degree
Level 7 For example, Masters level degree, PgDip
Level 8 For example, Doctorate/PhD

Section 5: Disabilities, Medical Conditions and Learning Support Details

Do you have any disabilities or learning difficulties?
Primary Disability/Learning Difficulty
Secondary Disability/Learning Difficulty




Please list any further disabilities, and tell us more about your difficulties and how it impacts on your learning? (For example: Having trouble relaxing, being restless or anxious, unable to read small text, needing instructions broken down or access to adaptive equipment).

Disability/Learning Difficulty Notes

Are you NOT able to exit the building without assistance in the event of an Emergency?

Section 6: Household


Describe best your household situation


Section 7 : Employment

Employment Status
Are you self Employed?

How many hours per week? (If employed)
Length of Unemployment (If Unemployed)

Choose which benefit you receive, if none please select No benefits

Section 8: Evidence

Please upload 1 form of Identification

Accepted forms of Identification:

  1. Current signed passport
  2. Original birth certificate (UK birth certificate issued within 12 months of the date of birth in full form including those issued by UK authorities overseas such as Embassies High Commissions and HM Forces)
  3. Current UK photocard driving licence
  4. Full old-style driving licence
  5. Residence permit issued by the Home Office to EEA nationals on sight of own country passport
  6. National identity card bearing a photograph of the applicant

You will also need to upload specific evidence for your Funding Declaration - please see the table below for what you should upload:

To evidence your eligibility:
Option Evidence to Upload
My Employer is Paying my Fees Please provide a Purchase Order, or letter of Confirmation from the Employer
I earn less than £21157 in inner London or £17004.00 outside GLA annual gross salary Please provide a P60, Payslip, Current Employment Contract or Universal Credit Statement
I receive Jobseeker’s Allowance (JSA) including those receiving National Insurance credits only Please provide a copy of your award notice or JSA payment confirmation
I receive Employment and Support Allowance (ESA) Please provide your ESA award notice
I receive Universal Credit Please provide a pay reference, or screenshot from the Universal Credit account, clearly showing your name
I receive other state benefits Please provide evidence of income from other state benefits, or confirmation letter
Type of Evidence
Notes
Upload File

Upload Photo

We will need you to provide a photograph for use on your student ID card. Also in order to ensure the safety and security of everyone at the institute

4MB Maximum file size, only jpg, png, jpeg and gif files are accepted


Click 'preview' to view a preview of your photo - if you are happy then click 'Upload' below the photo, otherwise you can cancel and upload another

Please ensure your photo is oriented the correct way round

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 (an executive agency of the DfE) and any successor bodies to these organisations. For the purposes of relevant data protection legislation, the DfE is the data controller for personal data processed by the ESFA. 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). Your information will be securely destroyed after it is no longer required for these purposes. Your information may be used for education, training, employment and well-being related purposes, including for research. The DfE and the English European Social Fund (ESF) Managing Authority (or agents acting on their behalf) may contact you in order for them to carry out research and evaluation to inform the effectiveness of training. Your information may also be shared with other third parties for the above purposes, but only where the law allows it and the sharing is in compliance with data protection legislation.

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: Privacy Notice Southend Adult Community College additionally collects personal data about you as a learner for academic and administrative purposes relating to the course you are studying and so that we can provide you with advice, guidance and support. Southend Adult Community College may also contact you from time to time about courses or learning opportunities that may be of interest to you and with regards to your progression and destination after you leave the course. Southend Adult Community College may pass information to other individuals and organisations for the purposes of administration, statistical analysis and research, careers guidance and other guidance and support. Such parties include educational establishments, colleges, universities, admissions services for universities (e.g. UCAS), sponsors/employers (e.g. information on your attendance and progress where they are providing you with time off or paying your fees), prospective employers, local authorities and your parents or guardians. Except where Southend Adult Community College has legal rights or obligations, Southend Adult Community College will not disclose your personal information to any other party or for any other reason other than as set out on this form without your prior consent.

Where sharing is not part of our statutory duties, you can give your consent to be contacted by other third parties about:











Please tick relevant boxes to give your consent.

Confirmation


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