Online Enrollment Form
Fill out the form carefully for enrollment
Title
Mr
Mrs
Miss
Ms
Dr
Other
Gender
Please Select
Male
Female
N/A
Learner Name
First Name
Middle Name
Last Name
Date of Birth
Age on the 31st August 2020
National Insurance Number
Learner email
Permanent home address
How long have you lived at this address? (years and months)
If you have not lived at the above address for at least 3 years, what was the postcode at your last address?
Mobile number
Home telephone number
Emergency contact name
Relationship to you
Emergency contact number
Is English your first language?
Yes
No
What was the last school / college / university you attended
Please select your preferred method of contact
Phone
Email
Post
SMS
Other
Please state your nationality
Are you a national of the UK or EEA country and have been a resident for the last three years or more?
Yes
NO (If no please select your reason for entry into the UK evidence will need to be seen)
If you are not a national of the UK or EEA please select as appropriate.
I am an asylum seeker
I have been granted discretionary leave to remain as a result of an asylum claim
I am on a visa, there is a restriction on the length of time I can stay in the UK
I am classed as the dependant of an EEA migrant worker and have been resident in the EEA for (please add how many) years
I have been recognised as a refugee in the UK
I have been granted exceptional leave to enter/remain as a result of an asylum claim
I have been granted humanitarian protection
Other (please state)
Visa details and expiry date:
Ethnicity
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
Other
99 Not provided
Do you have an Education health and care plan (EHC)
Yes
No
Do you consider yourself to have a disability, health problem or learning difficulties?
Yes
No
Date of entry into the UK
If yes, please select all the statements that apply to you:
Emotional / behavioural difficulties
Multiple disabilities
Visual impairment
Hearing impairment
Disability affecting mobility
Profound complex disabilities
Social and emotional difficulties
Mental health difficulty
Moderatelearning difficulty
Severe learning difficulty
Dyslexia
Dyscalculia
Autism spectrum disorder
Asperger's syndrome
Temporary Disability after illness (e.g. post viral or accident)
Other physical disability
Other specific learning difficulty (e.g. dyspraxia)
Other medical condition (e.g. asthma, epilepsy, diabetes)
Other learning difficulty
Other disability
Prefer not to say
Not provided
Do you require addition help from The Training Brokers
Yes
No
If Yes, what addition support is required
This can be discussed with your tutor
Do you have any unspent criminal convictions?
Yes
No
If yes, please give details.
Please select which statement matches your household circumstances.
No Household member is in employment and the household includes one or more dependent children.
No household member is in employment and the household does not include any dependent children.
Learner lives in a single adult household with dependent children
Learner has withheld this information
None of the above apply
Please select your employment status?
In paid employment
Self employed earning less than £17,500
Less than 16 hours
16 - 19 hours
20+ hours
Not employed
Do you earn less than £17,500
Yes
No
If yes, you need to send proof i.e. wage slips / P60.
If you are in employment, how long have you been working?
Less than 6 months
6-11 months
12-23 months
24-35 months
over 36 months
I am not in paid work
If employed please provide the name of the company you work for, including full address, telephone number and contact name.
If you are unemployed, please select as appropriate:
Not in paid employment, looking for work and available to start work
Not in paid employment, not looking for work and not available to start
How long have you been unemployed?
Less than 6 months
6-11 months
12-23 months
24-35 months
36+ months
What type of benefits are you claiming?
Jobseekers Allowance
Employment Support (Work Related Activity Group)
Universal Credit
Income Support
Council Tax Benefit (100%)
Housing Benefit
None
Any other state benefit (including all state benefits not just related to unemployment)
Proof of Benefit provided?
Yes
No
Please provide Proof of benefit.
Are you in full time education or any other funded training at the time of this enrollment?
Yes
No
Have you undertaken any learning in the last 3 years?
Yes
No
If you have selected yes, please state what course and / or qualification.
What is your highest level of qualification for maths?
No Qualification
GCSE
A level
NVQ
Functional Skills L1
Functional Skills L2
Please add the highest grade and the date/year of achievement
What is your highest level of qualification for English?
No Qualification
GCSE
A level
NVQ
Functional Skills L1
Functional Skills L2
Please add the highest grade and the date/year of achievement
Please state your highest level of other qualifications you have gained.
Please select your highest level of qualification
Entry Level
Other qualification below L1
Level 1
Full Level 2 (GCSE/O levels 5 or more at A*-C) or NVQ Level 2
Full Level 3 (2 or more A level passes, 4 or more AS levels or NVQ L3
Level 4
Level 5
Level 6
Level 7 or above
Other qualifications, level not known
Not known
No qualifications
Please tell us about your computer skills - select one of the following options that best describes you.
I have never used a computer before
I use a computer occasionally with help
I can use a computer independently for basic tasks without help
I regularly carry out general tasks using a variety of applications
I can confidently use a variety of applications
What is the title of your highest level of qualification and what year did you achieve this?
What are your reasons for learning (select as many options as apply to you)
To learn I.T. skills
To improve my skills
To improve my confidence
To improve my job prospects
To achieve a qualification
To prepare for further education
To improve my communication skills
To improve my number skills
To learn new skills to help in my current job
For personal interest
We may occasionally wish to update you on courses that may be of interest to you, your family or friends. To agree to be contacted for other purposes please select as appropriate
I do not wish to be contacted
I am happy to be contacted for courses or learning opportunities
I am happy to be contacted for surveys and research
I am happy to be contacted for jobs that meet my career aspirations.
Please select your preferred method of contact.
Post
Email
Telephone
Text
Consent form for the use of photography, testimonials and example of student work. Please select which areas you are happy for us to use:
Photography & Videos
Testimonials
Examples of work
Here at the Training Brokers we are really proud of the things we do, and the goals our students achieve. It's therefore no surprise that we would love to share this to spread the word about how The Training Brokers could work for anyone thanks to people like you.
Do you consent for The Training Brokers to share your work as in section 11 (for more information please contact us)
I give permission for the above information to be used as stated in section 11
I do not give permission
This will be part of your learning record and may be revoked at any time on request in writing
Qualifications / programme details. What skills would you like to develop?
How do you think the course can help ?
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