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Your Details
Title
Please Select
Miss - Miss
Mr - Mr
Mrs - Mrs
Ms - Ms
Othr - Other
Surname
First Name
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. JR100910B)
L26
Mobile
Gender
L13
Please Select
0 - Please Select
F - Female
M - Male
O - Other [Expired]
Ethnicity
L12
Please Select
31 - English / Welsh / Scottish / Northern Irish / British
32 - Irish
33 - Gypsy or Irish Traveller
34 - Any Other White background
35 - White and Black Caribbean
36 - White and Black African
37 - White and Asian
38 - Any Other Mixed / multiple ethnic background
39 - Indian
40 - Pakistani
41 - Bangladeshi
42 - Chinese
43 - Any other Asian background
44 - African
45 - Caribbean
46 - Any other Black / African / Caribbean background
47 - Arab
98 - Any other ethnic group
99 - Not provided
Email Address
L51
Prior Qualifications
L35
Please Select
1 - Entry Level
10 - Level 7 and above
2 - Level 1
3 - Level 2
4 - Full Level 2
5 - Level 3
6 - Full Level 3
7 - Level 4
8 - Level 5
9 - Level 6
97 - Other qualification, level not known
98 - Not known
99 - No qualifications
DOB (e.g. 26/07/1978)
L11
Learning Start Date
Planned End Date
Learning Actual End Date
Date Of Deletion
Tell us a bit more about yourself
Do you have a disability or health condition?
Please Select
1 - Yes
2 - No
9 - Prefer not To Say
LLDD and health problem categories
(Select All)
Asperger s syndrome (15)
Autism spectrum disorder (14)
Disability affecting mobility (6)
Dyscalculia (13)
Dyslexia (12)
Hearing impairment (5)
Mental health difficulty (9)
Moderate learning difficulty (10)
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)
Temporary disability after illness (for example post-viral) or accident
Vision impairment
Primary Category
Please Select
15 - Asperger s syndrome (15)
14 - Autism spectrum disorder (14)
6 - Disability affecting mobility (6)
13 - Dyscalculia (13)
12 - Dyslexia (12)
5 - Hearing impairment (5)
9 - Mental health difficulty (9)
10 - Moderate learning difficulty (10)
99 - Not provided DS (99)
97 - Other disability (97)
96 - Other learning difficulty (96)
95 - Other medical condition (for example epilepsy, asthma, diabetes)
93 - Other physical disability (93)
94 - Other specific learning difficulty (e.g. Dyspraxia)
98 - Prefer not to say (98)
7 - Profound complex disabilities (7)
11 - Severe learning difficulty (11)
8 - Social and emotional difficulties (8)
17 - Speech, Language and Communication Needs (17)
16 - Temporary disability after illness (for example post-viral) or accident
4 - Vision impairment
Learner Support Reason 1 (LSR) (13/14 Only)
Please Select
24 - ALG - Adult learning grant (Not Used From 12/13)
25 - EMA - not available for learners starting on or after 1 August 2011 (Not Used From 12/13)
32 - Professional and Career Development Loan (Skills Funding Agency funded learners only)
35 - PLA - E2E/Programme led apprenticeships hardship fund (Not Used From 12/13)
36 - Care to Learn
37 - RSS - Residential Support Scheme
41 - Time off for Study
49 - Learner Living On Campus (Accommodation Owned Or Managed By Provider)
50 - Learner Living Off Campus (Accommodation Leased By Provider And Sub-Let To Learner)
51 - Learner Living Off Campus (Privately Managed Accommodation On Provider Recommended List)
52 - Learner Living Off Campus (Privately Managed Accommodation Not On Provider Recommended List)
53 - Free Childcare for Training & Learning for Work (FCTLW) (Not Used From 12/13)
54 - Adult Education Bursary (AEB) (Skills Funding Agency funded learners only)
55 - 16-19 Bursary Fund learner is a member of a vulnerable group
56 - 16-19 Bursary Fund - learner has been awarded a discretionary bursary
57 - Residential support
58 - 19+ Hardship (Skills Funding Agency funded learners only)
59 - 20+ Childcare (Skills Funding Agency funded learners only)
60 - Residential Access Fund (Skills Funding Agency funded learners only)
61 - Unassigned
62 - Unassigned
63 - Unassigned
64 - Unassigned
65 - Unassigned
99 - No Learner Support or no more of the above
Learner Support Reason 2 (LSR) (13/14 Only)
Please Select
24 - ALG - Adult learning grant (Not Used From 12/13)
25 - EMA - not available for learners starting on or after 1 August 2011 (Not Used From 12/13)
32 - Professional and Career Development Loan (Skills Funding Agency funded learners only)
35 - PLA - E2E/Programme led apprenticeships hardship fund (Not Used From 12/13)
36 - Care to Learn
37 - RSS - Residential Support Scheme
41 - Time off for Study
49 - Learner Living On Campus (Accommodation Owned Or Managed By Provider)
50 - Learner Living Off Campus (Accommodation Leased By Provider And Sub-Let To Learner)
51 - Learner Living Off Campus (Privately Managed Accommodation On Provider Recommended List)
52 - Learner Living Off Campus (Privately Managed Accommodation Not On Provider Recommended List)
53 - Free Childcare for Training & Learning for Work (FCTLW) (Not Used From 12/13)
54 - Adult Education Bursary (AEB) (Skills Funding Agency funded learners only)
55 - 16-19 Bursary Fund learner is a member of a vulnerable group
56 - 16-19 Bursary Fund - learner has been awarded a discretionary bursary
57 - Residential support
58 - 19+ Hardship (Skills Funding Agency funded learners only)
59 - 20+ Childcare (Skills Funding Agency funded learners only)
60 - Residential Access Fund (Skills Funding Agency funded learners only)
61 - Unassigned
62 - Unassigned
63 - Unassigned
64 - Unassigned
65 - Unassigned
99 - No Learner Support or no more of the above
Learner Support Reason 3 (LSR) (13/14 Only)
Please Select
24 - ALG - Adult learning grant (Not Used From 12/13)
25 - EMA - not available for learners starting on or after 1 August 2011 (Not Used From 12/13)
32 - Professional and Career Development Loan (Skills Funding Agency funded learners only)
35 - PLA - E2E/Programme led apprenticeships hardship fund (Not Used From 12/13)
36 - Care to Learn
37 - RSS - Residential Support Scheme
41 - Time off for Study
49 - Learner Living On Campus (Accommodation Owned Or Managed By Provider)
50 - Learner Living Off Campus (Accommodation Leased By Provider And Sub-Let To Learner)
51 - Learner Living Off Campus (Privately Managed Accommodation On Provider Recommended List)
52 - Learner Living Off Campus (Privately Managed Accommodation Not On Provider Recommended List)
53 - Free Childcare for Training & Learning for Work (FCTLW) (Not Used From 12/13)
54 - Adult Education Bursary (AEB) (Skills Funding Agency funded learners only)
55 - 16-19 Bursary Fund learner is a member of a vulnerable group
56 - 16-19 Bursary Fund - learner has been awarded a discretionary bursary
57 - Residential support
58 - 19+ Hardship (Skills Funding Agency funded learners only)
59 - 20+ Childcare (Skills Funding Agency funded learners only)
60 - Residential Access Fund (Skills Funding Agency funded learners only)
61 - Unassigned
62 - Unassigned
63 - Unassigned
64 - Unassigned
65 - Unassigned
99 - No Learner Support or no more of the above
Learner Support Reason 4 (LSR) (13/14 Only)
Please Select
24 - ALG - Adult learning grant (Not Used From 12/13)
25 - EMA - not available for learners starting on or after 1 August 2011 (Not Used From 12/13)
32 - Professional and Career Development Loan (Skills Funding Agency funded learners only)
35 - PLA - E2E/Programme led apprenticeships hardship fund (Not Used From 12/13)
36 - Care to Learn
37 - RSS - Residential Support Scheme
41 - Time off for Study
49 - Learner Living On Campus (Accommodation Owned Or Managed By Provider)
50 - Learner Living Off Campus (Accommodation Leased By Provider And Sub-Let To Learner)
51 - Learner Living Off Campus (Privately Managed Accommodation On Provider Recommended List)
52 - Learner Living Off Campus (Privately Managed Accommodation Not On Provider Recommended List)
53 - Free Childcare for Training & Learning for Work (FCTLW) (Not Used From 12/13)
54 - Adult Education Bursary (AEB) (Skills Funding Agency funded learners only)
55 - 16-19 Bursary Fund learner is a member of a vulnerable group
56 - 16-19 Bursary Fund - learner has been awarded a discretionary bursary
57 - Residential support
58 - 19+ Hardship (Skills Funding Agency funded learners only)
59 - 20+ Childcare (Skills Funding Agency funded learners only)
60 - Residential Access Fund (Skills Funding Agency funded learners only)
61 - Unassigned
62 - Unassigned
63 - Unassigned
64 - Unassigned
65 - Unassigned
99 - No Learner Support or no more of the above
National Learner Monitoring 1 (NLM) (19/20 Only)
L40
Please Select
10 - Graduate Apprenticeship (Pre 2012/13 Do Not Use)
11 - Learner enrolled at an HE institution that returns an ILR (Pre 2012/13 Do Not Use)
12 - Learner following an ICT Skill for Life Qualification
13 - Learner following an ICT qualification at level 2 or below
14 - Tutors following an ICT qualification as a Skill for Life Development Course
15 - Ex-Carter and Carter learners
16 - Next Step Registration needed for learner
17 - Learner migrated as part of provider merger
18 - Learner moved as a result of Minimum Contract Level
19 - 1415 Data DO NOT USE
20 - 1415 Data DO NOT USE
99 - None specified (No return)
National Learner Monitoring 2 (NLM) (19/20 Only)
L40
Please Select
10 - Graduate Apprenticeship (Pre 2012/13 Do Not Use)
11 - Learner enrolled at an HE institution that returns an ILR (Pre 2012/13 Do Not Use)
12 - Learner following an ICT Skill for Life Qualification
13 - Learner following an ICT qualification at level 2 or below
14 - Tutors following an ICT qualification as a Skill for Life Development Course
15 - Ex-Carter and Carter learners
16 - Next Step Registration needed for learner
17 - Learner migrated as part of provider merger
18 - Learner moved as a result of Minimum Contract Level
19 - 1415 Data DO NOT USE
20 - 1415 Data DO NOT USE
99 - 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
04 - Part Time Employment
10 - Full Time Employment
11 - Unemployed
53 - Self Employed
54 - Entered Further Education
55 - Entered Higher Education
59 - Found Voluntary Work
61 - Death
75 - Full-time Education or Training
76 - Economically Inactive
77 - Not in Education, Employment or Training
95 - Continuing Existing Programme of Learning
97 - Other
98 - 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 - 1
2 - 2
3 - 3
4 - 4
5 - 5
6 - 6
7 - 7
8 - 8
9 - 9
A - A
A* - A*
AA - AA
AB - AB
AC - AC
AD - AD
AE - AE
AF - AF
AG - AG
B - B
B* - B*
BA - BA
BB - BB
BC - BC
BD - BD
BE - BE
BF - BF
BG - BG
C - C
C* - C*
CA - CA
CB - CB
CC - CC
CD - CD
CE - CE
CF - CF
CG - CG
D - D
D* - D*
DA - DA
DB - DB
DC - DC
DD - DD
DE - DE
DF - DF
DG - DG
E - E
E* - E*
EA - EA
EB - EB
EC - EC
ED - ED
EE - EE
EF - EF
EG - EG
F - F
F* - F*
FA - FA
FB - FB
FC - FC
FD - FD
FE - FE
FF - FF
FG - FG
G - G
G* - G*
GA - GA
GB - GB
GC - GC
GD - GD
GE - GE
GF - GF
GG - GG
NONE - Not Known
GCSE English qualification grade
Please Select
1 - 1
2 - 2
3 - 3
4 - 4
5 - 5
6 - 6
7 - 7
8 - 8
9 - 9
A - A
A* - A*
AA - AA
AB - AB
AC - AC
AD - AD
AE - AE
AF - AF
AG - AG
B - B
B* - B*
BA - BA
BB - BB
BC - BC
BD - BD
BE - BE
BF - BF
BG - BG
C - C
C* - C*
CA - CA
CB - CB
CC - CC
CD - CD
CE - CE
CF - CF
CG - CG
D - D
D* - D*
DA - DA
DB - DB
DC - DC
DD - DD
DE - DE
DF - DF
DG - DG
E - E
E* - E*
EA - EA
EB - EB
EC - EC
ED - ED
EE - EE
EF - EF
EG - EG
F - F
F* - F*
FA - FA
FB - FB
FC - FC
FD - FD
FE - FE
FF - FF
FG - FG
G - G
G* - G*
GA - GA
GB - GB
GC - GC
GD - GD
GE - GE
GF - GF
GG - GG
NONE - Not Known
Other Learner Fields
Discretionary Support Funds (DSF) 1.
L49
Please Select
01 - 19+ Hardships - Fees
03 - 19+ Hardships - General
04 - 16-18 Hardships - Transport
05 - 19+ Hardships - Transport
06 - 20+ Childcare
08 - 16-18 Hardship - books and equipment
09 - 16-18 Hardship - food and meals
10 - 16-18 Hardship - other
99 - None of the above
2.
L49
Please Select
01 - 19+ Hardships - Fees
03 - 19+ Hardships - General
04 - 16-18 Hardships - Transport
05 - 19+ Hardships - Transport
06 - 20+ Childcare
08 - 16-18 Hardship - books and equipment
09 - 16-18 Hardship - food and meals
10 - 16-18 Hardship - other
99 - None of the above
3.
L49
Please Select
01 - 19+ Hardships - Fees
03 - 19+ Hardships - General
04 - 16-18 Hardships - Transport
05 - 19+ Hardships - Transport
06 - 20+ Childcare
08 - 16-18 Hardship - books and equipment
09 - 16-18 Hardship - food and meals
10 - 16-18 Hardship - other
99 - None of the above
4.
L49
Please Select
01 - 19+ Hardships - Fees
03 - 19+ Hardships - General
04 - 16-18 Hardships - Transport
05 - 19+ Hardships - Transport
06 - 20+ Childcare
08 - 16-18 Hardship - books and equipment
09 - 16-18 Hardship - food and meals
10 - 16-18 Hardship - other
99 - None of the above
5.
L49
Please Select
01 - 19+ Hardships - Fees
03 - 19+ Hardships - General
04 - 16-18 Hardships - Transport
05 - 19+ Hardships - Transport
06 - 20+ Childcare
08 - 16-18 Hardship - books and equipment
09 - 16-18 Hardship - food and meals
10 - 16-18 Hardship - other
99 - None of the above
Eligibility for 16-18 Funding entitlement 1.
L28
Please Select
12 - 16-18 Funding entitlement
99 - Not Eligible for Enhanced Funding
2.
L28
Please Select
12 - 16-18 Funding entitlement
99 - Not Eligible for Enhanced Funding
Learning Difficulty Assessment (LDA)
Please Select
1 - Learner has been assessed as requiring additional learning support
2 - Learner has been assessed as requiring a high level of additional learning support (projected costs)
3 - Learner has been assessed as requiring a low level of additional learning support (projected costs)
Disadvantage Uplift Factor
L33
Please Select
01 - Deprived Area - postcode on file
02 - Deprived Area - postcode not on file
71 - Study Basic Skills Programme
98 - Other
99 - Not Eligible
Learning Support (ALS)
Please Select
1 - Learner has been assessed as requiring additional learning support
2 - Learner has been assessed as requiring a high level of additional learning support (projected costs)
3 - 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
5 - Learner is living away from home (in accommodation owned or managed by the provider)
Accommodation (13/14 only)
Please Select
5 - Learner is living away from home (in accommodation owned or managed by the provider)
Nature of Enquiry **Required**
Which Eat That Frog Group Centre would you like to attend?
Please Select
A - Newton Abbot
B - Paignton (Parkfield)
C - Plymouth
D - Torquay Union Street
E - Paignton (The Pad)
How did you hear about us?
Please Select
1 - Probation
2 - Friend/family recommendation
3 - JCP
4 - Health Practitioner
5 - Other referral (e.g. school)
6 - ETF Website
7 - ETF Staff Member
8 - Another website
9 - Local Authority
A - Leaflet / Poster
B - Facebook
C - Instagram
D - Twitter
E - LinkedIn
F - Email
G - Events
H - Library
I - Other
J - Unknown
Employment Status
Please Select
1 - Employed
2 - Unemployed
Test Record
No
Yes
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
Extra Field 1
Extra Field 2
Extra Field 3
Extra Field 4
Extra Field 5
Extra Field 6
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