Registration Form

About You

Title

Last Name

Given Name - as written on Passport, Driving Licence

Middle Name(s)

House Number/Name and Street

Area/Village

Town/City

Postcode (e.g. TF1 1AA)

Other Benefits Received if Applicable

Postcode Prior To Enrol

Landline No

National Insurance Number

Mobile

Sex

Ethnicity

Email Address

Prior Attainment

Date of Birth

Learning Start Date

End Date

Learning Actual End Date

Date Of Deletion

Supporting Your Learning

Declaration

How We Use Your Personal Information

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 shared with third parties for education, training, employment and well-being related purposes, including for research. This will only take place where the law allows it and the sharing is in compliance with data protection legislation.

The English European Social Fund (ESF) 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:

Restricted use indicator

Preferred method of contact

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:

Date Learner Viewed Declaration

Employment Status

Current highest qualifications

Highest Maths Qualification

Highest English Qualification

Other Learner Fields

See guidance below and confirm Ability to Share here.

1st Child Age

2nd Child Age

Name 2nd Child

How did you hear about the course?

Nationality

Benefits Received

Programme (Old)

Finish Code

Main Reason for Attending the Course

Test Record

Date Employed

Course Start Date

Date Start Notified

Date Finish Notified

Date Measure

How did you hear - 'Other' please State.

EMA

Sector Code

Campus Identifier

How did you hear about the Course?

How long have you lived at this Address?

1st Child Relationship

2nd Child Relationship

Other Reason for Attending the Course

Other Maths or English Qualification Grades

Venue

Enquiry Details

Are you a UK / EU/ EEA Citizen

When did you become resident in the UK?

Do you have right to live in the UK

Have you been resident in UK for last 3 years

if no, State your country of residence

if you are not a UK national, have you obtained pre / settled status under the EU settlement scheme

Date of exit into UK/EEA if there is a time limit

Please state your current status in UK by ticking one of the following options (Evidence is mandatory)

Are you attending any other funded training programme

If Yes, what are you studying?

Who is providing the training?

Contact me About:

Have you been referred by the Job Centre Plus (JCP)? If Yes which one?

Are you in receipt of any other state benefit (e.g income support) and would benefit from training to enter employment? If yes then detail the benefits

Do you have any additional income (take-home pay)? If Yes, what is your monthly additional income?

Proof of low wage (Evidence to be provided)

Employed & earn less than £25.000

Proof of SWAP Referral - Copy of referral notification attached (issued by Jobcentre Plus – setting out start date and times of training)

What areas of work interests you

Have you applied for any jobs

Do you have a full, clean driving licence

Employment Status

Have you ever been in paid employment

Are you self employed?

Please select the Hours you work if you are in Paid Employment.

Length of employment

How long have you been "Not Employed" ?

Enquiry Acceptance

Before Accepting please make sure you have read/accepted any declarations. You confirm that the data you have provided is correct at this time and that we may contact you as followup to arrange a meeting or collect additional information.

Data Security: We implement industry-standard security measures to protect your data from unauthorized access, disclosure, alteration, and destruction. You have the right to access, correct, or delete your personal information. To exercise these rights, please contact us.

Learner Accepted Accept

Onboarding Enrolment Section Including Course Fees

Evidence Seen

Household Situation

Emergency Contact Name

Emergency Contact Number

Emergency Contact Mobile Number

Emergency Contact Work Number

Emergency Contact (relationship to you)

Emergency Contact Address & postcode

Preferred Method of Contact

Do you consider yourself to be in financial hardship?

Do you have any unspent criminal convictions (If Yes, if you are applying for a course that will lead to employment working with children and / or vulnerable adults, answer next question)

Do you have any spent convictions, cautions, or repremands that are not "protected" (ie eligible for filtering by DBS) ?

Do you have any issues around drugs and or alcohol usage which may present a barrier to employment?

Do you have any other support needs or commitments that we need to be aware of?

Safeguarding - have any safeguarding or support needs been identified / disclosed

Do you consider yourself to belong to any of the following vulnerable groups

Do you have a current Educational Health Care Plan (EHC)HCP

Employer Job Title

Employment and / or benefit status Date Applied

Employer Name

Employer Address Line 1

Employer Address Line 2

Name 1st Child

Employer Post Code

Line Manager Name

Is Employer Small Employer?

Annual Salary (gross)

Indicate how you intend to pay for any fees due for your course

Planned Hours

Planned employability,enrichment and pastoral hours 24/25

Planned Learning Hours 24/25

Planned employability,enrichment and pastoral hours 23/24

Planned Learning Hours 23/24

Planned employability,enrichment and pastoral hours 22/23

Planned Learning Hours 22/23

Planned employability,enrichment and pastoral hours 21/22

Planned Learning Hours 21/22

Planned employability,enrichment and pastoral hours 20/21

Planned Learning Hours 20/21

Planned employability,enrichment and pastoral hours 19/20

Planned Learning Hours 19/20

Planned employability,enrichment and pastoral hours 18/19

Planned Learning Hours 18/19

Planned employability,enrichment and pastoral hours 17/18

Planned Learning Hours 17/18

Planned Learning Hours (16/17)

Planned Employability, Enrichment and Pastoral Hours (16/17)

Previous Planned Learning Hours (15/16)

Previous EEP Hours (15/16)

Submit

Application Form

Use the button below to review the Privacy Notice at the Learner Records Service. Select an option above to confirm that you are happy to share your PLR with Learn Telford

Declaration 1 Learn Telford and Declaration 2 ESFA. Please follow the links below to review the Privacy Policies.