First Name (required)
Home Address (required)
Date Of Birth (required)
NI Number (required)
Unique Learner Number
Home Phone (required)
Title Of Course & Level (required)
Section 2: Prior Qualifications
All learners must provide details of all prior qualifications and any other form of study as part of the Enrolment Form. If the learner has no qualifications please state ‘None’. Please enter all qualifications.
Level Of Study
Date Of Study
Section 3a: Ethnicity
How would you describe your ethnic origin or personal identity?
We are required to obtain this information to monitor the implementation of your Equality & Diversity Policy in relation to the Equality Act using the Government classification of Ethnicity.
Please indicate ethnicity
English/Welsh/Scottish/Northern Irish/British (31)Bangladeshi (41)Irish (32)Chinese (42)Gypsy or Irish Traveller (33)Any other Asian Background (43)Any Other White Background (34)African (44)White and Black Caribbean (35)Caribbean (45)White and Black African (36)Any other Black/African/Caribbean Background (46)White and Asian (37)Arab (47)Any other mixed/multiple ethnic background (38)Any other ethnic group (98)Indian (39)Not provided (99)Pakistani (40)
Section 3b: Support Requirements
All learners need to complete the below. We require this information to ensure that any support you need is available to you.
Please indicate any disabilities, learning difficulties and/or health problem
NONEVisual Impairment (4)Moderate Learning Difficulty (10)Hearing Impairment (5)Severe Learning Difficulty (11)Disability Affecting Mobility (6)Dyslexia (12)Other Physical Disability (93)Dyscalculia (13)Other Medical Condition (95)Other Specific Learning Difficulty (94)Social and emotional difficulties (8)Autism Spectrum Disorder (14)Mental Health difficulty (9)Other Learning Difficulty (96)Temporary Disability After Illness or accident (16)Profound Complex Disabilities (7)Not Provided (99)Asperger’s Syndrome (15)Other Disability (97)
Please indicate which of the above is your PRIMARY disability, learning difficulty and/or health problem
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