Registration Form

Your Details

Title

Surname

First Name

Middle Name(s)

House Number

Street / Road Name

Town / City

Current Postcode

County

Postcode

Home Telephone

NI Number (e.g. JR100910B)

Mobile

Gender

Ethnicity

Email Address

Prior Qualifications

DOB (e.g. 26/07/1978)

Learning Start Date

Planned End Date

Learning Actual End Date

Date Of Deletion

Tell us a bit more about yourself

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:

Other Learner Fields

Nature of Enquiry **Required**

National Identity

Benefits Received

Which Eat That Frog Group Centre would you like to attend?

How did you hear about us?

Employment Status

Test Record

Date Employed

Funding End Date

Date Start Notified

Date Finish Notified

Date Measure

Please state which course you are interested in

EMA

Sector Code

Campus Identifier

Client GroupL13

Enrolment Details

Evidence Seen

Household Situation

Emergency Contact Name

Emergency Contact Home Number

Emergency Contact Mobile Number

Emergency Contact Work Number

Emergency Contact (relationship to you)

Emergency Contact Address & postcode

Emergency Contact preferred contact method

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

Employer Town

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

Submit