Southend Adult Community College

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

Section 1 (continued): Your address

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? YesNo

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 D–G (1–3), Level 1 Award/Certificate/Diploma, ESOL, Functional Skills, NVQ Level 1, Music grades 1–3
Level 1	GCSE grades 1–3 / F–D, First Certificate, Level 1 Award/Certificate/Diploma, Functional Skills Level 1
Level 2	Vocational and technical qualifications at level 2, Functional Skills Level 2, ESOL
Full Level 2	5+ GCSEs grades A*–C (or grade 4+), 1 A Level, NVQ Level 2, GNVQ Intermediate
Level 3	Vocational and technical qualifications at level 3, Core Maths, Technical qualifications
Full Level 3	2+ A Levels, QCF Diploma Level 3, QAA Access to HE, GNVQ Advanced, NVQ Level 3
Level 4	Certificate of Higher Education, Higher Apprenticeship, HNC
Level 5	Diploma of Higher Education, Foundation Degree, HND
Level 6	Degree Apprenticeship, Honours Degree
Level 7	Masters Degree, PgDip
Level 8	Doctorate / PhD

Section 5: Disabilities, medical conditions and learning support

Do you have any disabilities or learning difficulties? YesNo

Primary Disability / Learning Difficulty

Secondary Disability / Learning Difficulty

Please describe any further disabilities and how they impact your learning:

Disability / Learning Difficulty Notes

Section 6: Household situation

Which best describes your household situation?

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

I live in a single adult household with dependent children, and no member of the household is in employment

I don't wish to say

None of these apply to me

Section 7: Employment

Employment Status

Are you self-employed? YesNo

How many hours per week? (if employed)

Length of unemployment (if unemployed)

Which benefit do you receive? (select "No benefits" if none apply)

Section 8: Evidence of identity

Please upload 1 form of identification. Accepted documents:

Current signed passport
Original birth certificate (issued within 12 months of date of birth)
Current UK photocard driving licence
Full old-style driving licence
Residence permit issued by the Home Office to EEA nationals
National identity card bearing a photograph of the applicant

Evidence required for your funding declaration:

Funding option	Evidence to upload
My employer is paying my fees	Purchase Order or letter of confirmation from the employer
I earn less than £17,004 gross annually	P60, payslip, employment contract or Universal Credit statement
Job Seekers Allowance (JSA)	Award notice or JSA payment confirmation
Employment and Support Allowance (ESA)	ESA award notice
Universal Credit	Pay reference or screenshot from Universal Credit account showing your name
Other state benefits	Evidence of income or confirmation letter

Type of evidence

Notes

Upload file

Photo for student ID

Please upload a passport-style photo for your student ID card and our student records system. If taking the photo on a mobile device, hold it upright (portrait). Please ensure the photo is appropriate for an ID card.

Accepted formats: JPG, JPEG, PNG, GIF — maximum 4 MB.

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.

Where sharing is not part of our statutory duties, please indicate your consent preferences:

Confirmation

I confirm I have read and understand the information above, and that all information provided is accurate to the best of my knowledge.

Security check

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Section 1: Personal details

Section 1 (continued): Your address

Section 2: Next of kin / emergency contacts

Section 3: Residency

Section 4: Education

Section 5: Disabilities, medical conditions and learning support

Section 6: Household situation

Section 7: Employment

Section 8: Evidence of identity

Evidence required for your funding declaration:

Photo for student ID

Privacy and data sharing

Where sharing is not part of our statutory duties, please indicate your consent preferences:

Confirmation

Security check

Retype the characters from the picture:

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