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Your Details
Title
Please Select
Miss
Mr
Mrs
Ms
Other
Surname * Required
First Name * Required
Middle Name(s)
House number
L18
Street / Road Name
L19
Town / City
L20
Current Postcode
L22
County
L21
Postcode
Home Telephone
L23
NI Number (e.g. JR961007B)
L26
Mobile
Gender
L13
Please Select
Female
Male
Other
Transgender
Ethnicity
L12
Please Select
English / Welsh / Scottish / Northern Irish / British
Irish
Gypsy or Irish Traveller
Any Other White background
White and Black Caribbean
White and Black African
White and Asian
Any Other Mixed / multiple ethnic background
Indian
Pakistani
Bangladeshi
Chinese
Any other Asian background
African
Caribbean
Any other Black / African / Caribbean background
Arab
Any other ethnic group
Not provided
Email Address
L51
Prior Qualifications
L35
Please Select
Entry Level (e.g. ESOL / Skills for Life)
Level 1 (e.g. GCSE grades 3, 2, 1 or grades D, E, F, G)
Full Level 2 (e.g. GCSE - grades 9, 8, 7, 6, 5, 4 or grades A*, A, B, C)
Full Level 3 (e.g. A Level, Advanced Apprenticeship)
Level 4 (e.g. CertHE, HNC, Level 4 NVQ)
Level 5 (e.g. DipHE, HND, Level 5 NVQ)
Level 6 (e.g. Degree, Level 6 NVQ)
Level 7 and above (e.g. Masters, PGCE, Level 7 NVQ)
No Qualifications
Other Qualification, Level not known
DOB (e.g. 26/07/1978)
L11
Learning Start Date
Planned End Date
Learning Actual End Date
Date Of Deletion
Tell us a little more about yourself
Do you have a Disability or Health Condition?
Please Select
Yes
No
Not Known
LLDD and health problem categories
(Select All)
Asperger s syndrome (15)
Autism spectrum disorder (14)
Disability affecting mobility (6)
Dyscalculia (13)
Dyslexia (12)
Emotional/behavioural difficulties (1)
Hearing impairment (5)
Mental health difficulty (9)
Moderate learning difficulty (10)
Multiple disabilities (2)
Multiple learning difficulties (3)
Not provided DS (99)
Other disability (97)
Other learning difficulty (96)
Other medical condition (for example epilepsy, asthma, diabetes)
Other physical disability (93)
Other specific learning difficulty (e.g. Dyspraxia)
Prefer not to say (98)
Profound complex disabilities (7)
Severe learning difficulty (11)
Social and emotional difficulties (8)
Speech, Language and Communication Needs (17) 16-17 Code
Temporary disability after illness (for example post-viral) or accident
Vision impairment
Primary Category
Please Select
Asperger s syndrome (15)
Autism spectrum disorder (14)
Disability affecting mobility (6)
Dyscalculia (13)
Dyslexia (12)
Emotional/behavioural difficulties (1)
Hearing impairment (5)
Mental health difficulty (9)
Moderate learning difficulty (10)
Multiple disabilities (2)
Multiple learning difficulties (3)
Not provided DS (99)
Other disability (97)
Other learning difficulty (96)
Other medical condition (for example epilepsy, asthma, diabetes)
Other physical disability (93)
Other specific learning difficulty (e.g. Dyspraxia)
Prefer not to say (98)
Profound complex disabilities (7)
Severe learning difficulty (11)
Social and emotional difficulties (8)
Speech, Language and Communication Needs (17) 16-17 Code
Temporary disability after illness (for example post-viral) or accident
Vision impairment
Learner Support Reason 1 (LSR) (13/14 Only)
Please Select
ALG - Adult learning grant (Not Used From 12/13)
EMA - not available for learners starting on or after 1 August 2011 (Not Used From 12/13)
Professional and Career Development Loan (Skills Funding Agency funded learners only)
PLA - E2E/Programme led apprenticeships hardship fund (Not Used From 12/13)
Care to Learn
RSS - Residential Support Scheme
Time off for Study
Learner Living On Campus (Accommodation Owned Or Managed By Provider)
Learner Living Off Campus (Accommodation Leased By Provider And Sub-Let To Learner)
Learner Living Off Campus (Privately Managed Accommodation On Provider Recommended List)
Learner Living Off Campus (Privately Managed Accommodation Not On Provider Recommended List)
Free Childcare for Training & Learning for Work (FCTLW) (Not Used From 12/13)
Adult Education Bursary (AEB) (Skills Funding Agency funded learners only)
16-19 Bursary Fund learner is a member of a vulnerable group
16-19 Bursary Fund - learner has been awarded a discretionary bursary
Residential support
19+ Hardship (Skills Funding Agency funded learners only)
20+ Childcare (Skills Funding Agency funded learners only)
Residential Access Fund (Skills Funding Agency funded learners only)
Unassigned
Unassigned
Unassigned
Unassigned
Unassigned
No Learner Support or no more of the above
Learner Support Reason 2 (LSR) (13/14 Only)
Please Select
ALG - Adult learning grant (Not Used From 12/13)
EMA - not available for learners starting on or after 1 August 2011 (Not Used From 12/13)
Professional and Career Development Loan (Skills Funding Agency funded learners only)
PLA - E2E/Programme led apprenticeships hardship fund (Not Used From 12/13)
Care to Learn
RSS - Residential Support Scheme
Time off for Study
Learner Living On Campus (Accommodation Owned Or Managed By Provider)
Learner Living Off Campus (Accommodation Leased By Provider And Sub-Let To Learner)
Learner Living Off Campus (Privately Managed Accommodation On Provider Recommended List)
Learner Living Off Campus (Privately Managed Accommodation Not On Provider Recommended List)
Free Childcare for Training & Learning for Work (FCTLW) (Not Used From 12/13)
Adult Education Bursary (AEB) (Skills Funding Agency funded learners only)
16-19 Bursary Fund learner is a member of a vulnerable group
16-19 Bursary Fund - learner has been awarded a discretionary bursary
Residential support
19+ Hardship (Skills Funding Agency funded learners only)
20+ Childcare (Skills Funding Agency funded learners only)
Residential Access Fund (Skills Funding Agency funded learners only)
Unassigned
Unassigned
Unassigned
Unassigned
Unassigned
No Learner Support or no more of the above
Learner Support Reason 3 (LSR) (13/14 Only)
Please Select
ALG - Adult learning grant (Not Used From 12/13)
EMA - not available for learners starting on or after 1 August 2011 (Not Used From 12/13)
Professional and Career Development Loan (Skills Funding Agency funded learners only)
PLA - E2E/Programme led apprenticeships hardship fund (Not Used From 12/13)
Care to Learn
RSS - Residential Support Scheme
Time off for Study
Learner Living On Campus (Accommodation Owned Or Managed By Provider)
Learner Living Off Campus (Accommodation Leased By Provider And Sub-Let To Learner)
Learner Living Off Campus (Privately Managed Accommodation On Provider Recommended List)
Learner Living Off Campus (Privately Managed Accommodation Not On Provider Recommended List)
Free Childcare for Training & Learning for Work (FCTLW) (Not Used From 12/13)
Adult Education Bursary (AEB) (Skills Funding Agency funded learners only)
16-19 Bursary Fund learner is a member of a vulnerable group
16-19 Bursary Fund - learner has been awarded a discretionary bursary
Residential support
19+ Hardship (Skills Funding Agency funded learners only)
20+ Childcare (Skills Funding Agency funded learners only)
Residential Access Fund (Skills Funding Agency funded learners only)
Unassigned
Unassigned
Unassigned
Unassigned
Unassigned
No Learner Support or no more of the above
Learner Support Reason 4 (LSR) (13/14 Only)
Please Select
ALG - Adult learning grant (Not Used From 12/13)
EMA - not available for learners starting on or after 1 August 2011 (Not Used From 12/13)
Professional and Career Development Loan (Skills Funding Agency funded learners only)
PLA - E2E/Programme led apprenticeships hardship fund (Not Used From 12/13)
Care to Learn
RSS - Residential Support Scheme
Time off for Study
Learner Living On Campus (Accommodation Owned Or Managed By Provider)
Learner Living Off Campus (Accommodation Leased By Provider And Sub-Let To Learner)
Learner Living Off Campus (Privately Managed Accommodation On Provider Recommended List)
Learner Living Off Campus (Privately Managed Accommodation Not On Provider Recommended List)
Free Childcare for Training & Learning for Work (FCTLW) (Not Used From 12/13)
Adult Education Bursary (AEB) (Skills Funding Agency funded learners only)
16-19 Bursary Fund learner is a member of a vulnerable group
16-19 Bursary Fund - learner has been awarded a discretionary bursary
Residential support
19+ Hardship (Skills Funding Agency funded learners only)
20+ Childcare (Skills Funding Agency funded learners only)
Residential Access Fund (Skills Funding Agency funded learners only)
Unassigned
Unassigned
Unassigned
Unassigned
Unassigned
No Learner Support or no more of the above
National Learner Monitoring 1 (NLM) (19/20 Only)
L40
Please Select
Graduate Apprenticeship (Pre 2012/13 Do Not Use)
Learner enrolled at an HE institution that returns an ILR (Pre 2012/13 Do Not Use)
Learner following an ICT Skill for Life Qualification
Learner following an ICT qualification at level 2 or below
Tutors following an ICT qualification as a Skill for Life Development Course
Ex-Carter and Carter learners
Next Step Registration needed for learner
Learner migrated as part of provider merger
Learner moved as a result of Minimum Contract Level
None specified (No return)
National Learner Monitoring 2 (NLM) (19/20 Only)
L40
Please Select
Graduate Apprenticeship (Pre 2012/13 Do Not Use)
Learner enrolled at an HE institution that returns an ILR (Pre 2012/13 Do Not Use)
Learner following an ICT Skill for Life Qualification
Learner following an ICT qualification at level 2 or below
Tutors following an ICT qualification as a Skill for Life Development Course
Ex-Carter and Carter learners
Next Step Registration needed for learner
Learner migrated as part of provider merger
Learner moved as a result of Minimum Contract Level
None specified (No return)
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
(Select All)
Learner is not to be contacted, for example where a learner has suffered severe illness during the programme or other circumstance
Learner is not to be contacted - learner has died
Learner agrees to be contacted about courses or learning opportunities
Learner agrees to be contacted for survey and research
Preferred method of contact
(Select All)
Learner agrees to be contacted by post
Learner agrees to be contacted by telephone
Learner agrees to be contacted by e-mail
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:
https://www.gov.uk/government/publications/esfa-privacy-notice
Date Learner Viewed Declaration
Provider Specified Learner Monitoring
Provider Specified Learner Monitoring 1.
L42
2.
L42
Destination Information
Destination
L39
Please Select
Part Time Employment
Full Time Employment
Unemployed
Self Employed
Entered Further Education
Entered Higher Education
Found Voluntary Work
Death
Full-time Education or Training
Economically Inactive
Not in Education, Employment or Training
Continuing Existing Programme of Learning
Other
Destination Unknown
Employment Status: *** PLEASE USE THE EMPLOYMENT STATUS TAB TO UPDATE/INSERT THE EMPLOYMENT STATUS RECORDS ***
Previous Grades
GCSE maths qualification grade
Please Select
1
2
3
4
5
6
7
8
9
A
A*
AA
AB
AC
AD
AE
AF
AG
B
B*
BA
BB
BC
BD
BE
BF
BG
C
C*
CA
CB
CC
CD
CE
CF
CG
D
D*
DA
DB
DC
DD
DE
DF
DG
E
E*
EA
EB
EC
ED
EE
EF
EG
F
F*
FA
FB
FC
FD
FE
FF
FG
G
G*
GA
GB
GC
GD
GE
GF
GG
Not Known
GCSE English qualification grade
Please Select
1
2
3
4
5
6
7
8
9
A
A*
AA
AB
AC
AD
AE
AF
AG
B
B*
BA
BB
BC
BD
BE
BF
BG
C
C*
CA
CB
CC
CD
CE
CF
CG
D
D*
DA
DB
DC
DD
DE
DF
DG
E
E*
EA
EB
EC
ED
EE
EF
EG
F
F*
FA
FB
FC
FD
FE
FF
FG
G
G*
GA
GB
GC
GD
GE
GF
GG
Not Known
Other Learner Fields
Discretionary Support Funds (DSF) 1.
L49
Please Select
19+ Hardships - Fees
19+ Hardships - General
16-18 Hardships - Transport
19+ Hardships - Transport
20+ Childcare
16-18 Hardship - books and equipment
16-18 Hardship - food and meals
16-18 Hardship - other
None of the above
2.
L49
Please Select
19+ Hardships - Fees
19+ Hardships - General
16-18 Hardships - Transport
19+ Hardships - Transport
20+ Childcare
16-18 Hardship - books and equipment
16-18 Hardship - food and meals
16-18 Hardship - other
None of the above
3.
L49
Please Select
19+ Hardships - Fees
19+ Hardships - General
16-18 Hardships - Transport
19+ Hardships - Transport
20+ Childcare
16-18 Hardship - books and equipment
16-18 Hardship - food and meals
16-18 Hardship - other
None of the above
4.
L49
Please Select
19+ Hardships - Fees
19+ Hardships - General
16-18 Hardships - Transport
19+ Hardships - Transport
20+ Childcare
16-18 Hardship - books and equipment
16-18 Hardship - food and meals
16-18 Hardship - other
None of the above
5.
L49
Please Select
19+ Hardships - Fees
19+ Hardships - General
16-18 Hardships - Transport
19+ Hardships - Transport
20+ Childcare
16-18 Hardship - books and equipment
16-18 Hardship - food and meals
16-18 Hardship - other
None of the above
Eligibility for 16-18 Funding entitlement 1.
L28
Please Select
16-18 Funding entitlement
Not Eligible for Enhanced Funding
2.
L28
Please Select
16-18 Funding entitlement
Not Eligible for Enhanced Funding
Learning Difficulty Assessment (LDA)
Please Select
Learner has been assessed as requiring additional learning support
Learner has been assessed as requiring a high level of additional learning support (projected costs)
Learner has been assessed as requiring a low level of additional learning support (projected costs)
Disadvantage Uplift Factor
L33
Please Select
Deprived Area - postcode on file
Deprived Area - postcode not on file
Study Basic Skills Programme
Other
Not Eligible
Learning Support (ALS)
Please Select
Learner has been assessed as requiring additional learning support
Learner has been assessed as requiring a high level of additional learning support (projected costs)
Learner has been assessed as requiring a low level of additional learning support (projected costs)
Additional Learning Support Pre 13/14
Learning Support Cost (Current)
Learning Support Cost 13/14
Local LSC Learner Monitoring 1.
L41
Local LSC Learner Monitoring 2.
L41
Accommodation (Current)
Please Select
Learner is living away from home (in accommodation owned or managed by the provider)
Accommodation (13/14 only)
Please Select
Learner is living away from home (in accommodation owned or managed by the provider)
Employment Information ** Required
Type of Benefits received (if applicable)
Please Select
Universal Credit
JSA
Other benefits
Length of Unemployment
Please Select
6 months
6 - 11 months
1 - 2 yrs
2 yrs +
Current Employment Status
Please Select
Employed
Not employed, looking for work
Not employed, not looking for work
Test Record
No
Yes
Date Employed
Funding End Date
Date Start Notified
Date Finish Notified
Date Measure
Please type here what your enquiry is about
How many hours do you work per week?
Sector Code
Campus Identifier
How long have you been employed?
Extra Field 2
Extra Field 3
Extra Field 4
Extra Field 5
Extra Field 6
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