ELATT Learning Agreement | Sixth Form

Adaptation Declaration for Learner

The following declaration form must be completed for each learner and retained with the learner portfolio/evidence to support an application to access the agreed qualification adaptations linked to the Covid-19 crisis.

This form confirms that the learner has met all of the required conditions laid out by City & Guilds/ILM and that the process followed has been subject to Internal Quality Assurance.
Learner Name:*
ENR Number:*
Centre Name:*
Centre Number:*
Date of learner registration:*

DayMonthYear
Date
Qualification Details

Please enter the relevant Qualification title and 6 digit Qualification number below.
Assessment Team Details
Assessor Name:*
Assessor Signature:*

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Co-signing Assessor Name (if needed):
Co-signing Assessor Signature:

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Internal Quality Assurer Name:*
Internal Quality Assurer Signature:*

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Co-signing Internal Quality Assurer Name (if needed):
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Only complete the table relevant to this learner where adaptation has been applied.
Qualification Title and Number:*
Declaration of Assessor and Internal Quality Assurer

I confirm that:
- the learner’s situation has met the requirements for adaptation of assessment.
- the learner work has been assessed, the assessment has been quality assured and that all requirements have been met.
- the certificate can be claimed.
Assessor:
Assessor Name:*
Assessor Signature:*

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Date*

DayMonthYear
Date
Co-signing Assessor Name (if needed):
Co-signing Assessor Signature:

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Date

DayMonthYear
Date
Internal Quality Assurer:
Internal Quality Assurer Name:*
Internal Quality Assurer Signature:*

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Date*

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Date
Co-signing Internal Quality Assurer Name (if needed):
Co-signing Internal Quality Assurer Signature:

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Date

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Date
Should be Empty: