Enrolment Form

Enrolment Form & Learning Agreement 17/18

Standard Code:

1. Personal Details










Address Details








1.1 Emergency Contact Details












2. Ethnic Origin



3. Nationality







Note: If you haven't always resided in the UK we will need to see your passport at enrolment




4. Disabilities & Learning Difficulties



4.1 If you have more than one learning difficulty and/or disability please state which is your primary

Visual Impairment Hearing Impairment Disability Affecting Mobility Profound Complex Disabilities Social and Emotional Difficulties Mental Health Difficulty Moderate Learning Difficulty Severe Learning Difficulty Dyslexia Dyscalculia
Autism Spectrum Disorder Asperger's Syndrome Temporary Disability after illness Speech, language & communication needs Other physical disability Other Specific Learning Difficulty Other Medical Condition Other Learning Difficulty Other Disabilities Prefer not to say

Standard Code:


Entry Level Level 1 Full Level 2 Full Level 3 Level 4 Level 5 Level 6 Level 7 Other Qualifications / Not Known Prefer not to say

GCSE X Or U or no previous qualifications Functional Skills Entry Level Functional Skills Entry Level 2 Functional Skills Entry Level 3 Functional Skills Entry Level 1* Functional Skills Entry Level 2 GCSE E-G GCSE D GCSE A* - C
English
Maths

I have exemptions for my level 1 functional skills elements and wish to complete my Level 2's I have exemptions for my level 1 functional skills elements and do not wish to complete my Level 2's

6. Household Situation

No Household member is in employment and the household includes one or more dependant children No Household member is in employment and the household does not include any dependant children Learner lives in a single adult household and with dependant children Prefer not to say None of the HHS1, HHS2, or HHS3 applies

Up to 3 Months 4-6 Months 7-12 Months 12+ Months

Less than 16 Hours a week 16-19 Months a week 20-29 Hours a week 30 Hours and above a week

Less than 6 Months 6-11 Months 12-23 Months 24-35 Months Over 36 Months

In receipt of JSA In receipt of ESA Other Benefits Universal Credits

Full-time education or training Self Employed Other

7. Your Choice Of Course (This will be filled out by ESP)


8. Employment Details






9. Self Declaration

I am aged 19-23 and enrolling on a entry level 1/2/3 or level programme (not ESOL), English or Maths) and do not currently hold a Qualification at Level 2 or above I am enrolling on any first full level 2 or below qualification and do not currently hold a qualification at level 2 or above I am enrolling on functional skills English & Maths course or GCSE Maths/English and do not hold grade C or above in the subject I am aged 19-23 and enrolling on my first full leve 3 or level 4 qualification and do not currently hold a qualification level 3 or above

JSA, ESA or Universal Credit OR Means Tested Other State Benefit other than JSA, ESA or Universal Credit

I served a minimum or 4 years I completed basic training but server less than 4 years due to medical discharge througbh injury in active service



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10. PAYMENT BY EMPLOYER – NON LEVY FUNDED LEARNERS ONLY

As part of the new Levy funding guidelines 01/05/2017, if you are a non levy paying employer you will share the cost of training and assessment with the government, this is called “co-investment”, you (the employer) will pay 10% towards the cost of training while the government will pay the remaining 90% up to the maximum funding band (for more information please visit
https://www.gov.uk/government/publications/apprenticeship-levy-how-it-will-work/apprenticeship-levy-how-it-will-work#non-levy-paying- employers)










SAFEGUARDING CHILDREN, YOUNG PEOPLE AND VULNERABLE ADULTS

ESP is keen to support all students to help them succeed. For some careers you will need to declare all criminal convictions including those that are spent. We ask that you declare all unspent criminal convictions, doing this will not necessarily stop you being offered a place on the course.


If you are unsure on what to declare then please seek advice from our student advisor or ask a careers advisor at the national careers service at https://nationalcareersservice.direct.gov.uk.

Yes No

If you have declared that you have an unspent criminal conviction you will receive a letter with an attached form. You will have 10 days to return the form to ESP who will review your disclosure and will inform you of any actions we may take. They may ask you to come in for an interview to further discuss your disclosure. Please note that failing to complete this section or providing false information may lead to your application/enrolment being withdrawn.

LEARNING AGREEMENT

  • Opportunities for regular assessment, review of your progress and recording of your achievements
  • Opportunities for individual advice, guidance and support at all stages of your learning
  • Reasonable access to appropriate facilities , resources and equipment
  • Agreed learning and learner support
  • Opportunities to comment on your learning programme
  • An action plan to support your progress to further/higher education and training or employment
  • Equality of opportunity

IN SIGNING THIS LEARNING AGREEMENT YOU ARE;

  • That you have received appropriate advice and guidance on your choice of programme to assess your suitability in accordance with ESP procedures
  • To accept responsibilities for your own learning and to review your progress with the support of your tutor(s). To attend all required
    activities regularly and punctually and to account for any absences .
  • To take responsibility for maintaining an acceptable standard of behaviour whilst engaged in activities associated with ESP.
  • To complete all of your work to the best of your ability an d within specified deadlines , as required by your programme.
  • To follow and respect published policies, rules, regulations, copies of which are available
  • That the information on this enrolment form/learning agreement is correct and that you will inform ESP of any future changes.
  • To look after all resources during use and make sure they are properly issued and returned on time
  • To comply with copyright laws and licenses regarding to copying of resources including all DVD’S and audio
  • If you are under the age of 19 – on the 31st August 2017, we will share relevant information, all academic year, about your studies with your parent/guardian.
  • We will share information about your studies if your employer is paying your fees .
  • EXAMINATIONS AND REGISTRATIONS

    All students are themselves wholly responsible for their entry to examinations. Notices giving closing dates for the receipt of all examination entries are displayed and students should carefully observe the information thereon. Alternative arrangements cannot be made for students on holiday during examination periods.

    DATA PROTECTION & YOUR PERSONAL INFORMATION – How we use your personal information

    By providing the information contained in the enrolment form you consent to ESP holding and processing the information as set out in our registration. As part of audit and compliance ESP may be required to share your details with third parties however ESP will ensure that we comply with the general data protection regulation at all times. It will also be used by the Education and Skills Funding Agency (ESFA) an exclusive agency of the department for education (DFE) for statistical analysis and to issue you with a unique learner number (ULN), and to create your personal learning record. For more information about how your information is processed and shared refer to the extended privacy notices on Gov.uk
    Https://www.gov.uk/government/publications/lrs-privacy-notices Https://www.gov.uk/government/publications/sfa-privacy-notices

    You can opt out of contact by the ESP & ESFA by ticking any of the following boxes; if you do not wish to be contacted;

    About New Courses Surveys and research By Post By Phone
    Learning Opportunities Surveys and research By Post By Phone

    Learner Declaration

    I confirm that the details I have given on all sides of this form are correct. I have received enough information about the courses(s) for which I am enrolling to make an informed choice and I am aware of the range or support that is available to help my learning.












    Any Problems please use the contact button on the top to get in contact with us.

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