Green Skills Retrofit Bootcamp Enrolment Form

Green Skills Retrofit Skills Bootcamp Enrolment Form
1. PERSONAL DETAILS
Are you currently in education with another provider?*

YesNo
If yes, which one?
Please tick the box below to confirm that you have NOT attended another skills bootcamp between 1st April 2025 and 31st March 2026*

I confirm I have NOT attended as per the above dates
Title (Mr/Mrs/Miss/Other)
Full Name (please enter your name as shown on your ID)*

First NameMiddle NameLast Name
Sex (Male or Female)*
Pronouns (e.g. he, she, they etc)
Date of Birth*
Contact Telephone Number*
Please enter a valid phone number
Contact Email Address*
National Insurance Number*
Address
Address*

Street Address

Street Address Line 2

CityCounty

PostcodeCountry
Emergency Contact
Emergency Contact Name*

First NameLast Name
Relationship*
Emergency Contact Number*
Please enter a valid phone number
2. YOUR CHOICE OF PROGRAMME
Course Name (Please select course and date below)*
Green Skills Retrofit Skills Bootcamp 02 Qualifications :

NOCN L2 Award in Understanding Domestic Retrofit
NOCN L3 Certificate in Installing External Wall Insulation
NOCN L3 Certificate in Applying Surface Finish to External Wall Insulation
NOCN L1 Award in Health and Safety in a Construction Environment
Working At Height (non-accredited)
Working in Confined Spaces (non-accredited)

Green Skills Retrofit SWAP 01 & Skills Bootcamp 02 Qualifications :

Gateway Entry 3 Award in Employability Skills
NOCN L2 Award in Understanding Domestic Retrofit
NOCN L1 Award in Health and Safety in a Construction Environment
Introduction to External Wall Insulation (non-accredited)
NOCN L3 Certificate in Installing External Wall Insulation
NOCN L3 Certificate in Applying Surface Finish to External Wall Insulation
Working At Height (non-accredited)
Working in Confined Spaces (non-accredited)
3. INFORMATION TO ASSESS YOUR ELIGIBILITY
a.) Are you (please tick)*

EnglishIrishScottishWelshNorthern IrishOther nationality
Are you any other nationality? If so, please state here;
b.) Have you lived in the UK for the previous 3 years?

YesNo
c.) Have you lived in the UK* all of your life? *Excludes Channel Islands and Isle of Man*

Yes - if yes, go to Section 4 - Equal OpportunitiesNo - if no, go to part d.
d.) In which country do you normally live?
e.) Which country did you live in before coming to the UK?
f.) How long did you live there?
g.) Do you have any restrictions on the amount of time you may stay in the UK?

NoYes - if yes, go to h.
h.) If yes? What is the expiry date?
i.) Reason for being in the UK?

To study (note: student visas holders must study a full-time programme)To workTo visit (note: you can only study if you have a student visitor or child visitor visa)To join spouse/civil partnerTo accompany parentsRefugee statusAsylum seekerOther
4. EQUAL OPPORTUNITIES

We are committed to equal opportunities. To help us monitor our policy, please complete the following.
Ethnicity*

English / Welsh / Scottish / Northern Irish BritishIrishGypsy or Irish TravellerAny other White backgroundWhite and Black CaribbeanWhite and Black AfricanWhite and AsianAny other Mixed / Multiple Ethnic backgroundIndianPakistaniBangladeshiChineseAny other Asian backgroundAfricanCaribbeanAny other Black / African / Caribbean backgroundArab
DISABILITIES / LEARNING DIFFICULTIES The college welcomes students with disabilities. The information you supply will be used to identify support needs. Please mark the box (s) which describe your disability / learning difficulty:

No disability / difficultyVisual impairmentHearing impairmentAsperger's SyndromeDisability affecting mobilityMental health difficultyAutism spectrum disorderDyslexiaDyscalculiaA medical condition or disability not listed above (eg epilepsy, asthma) - if you select this, please specify below.
Please specify disability or medical condition not specified above;
5. PRIOR ATTAINMENT

Please check the options below starting at the top. Tick each line if the description of qualifications apply to you.
NVQ Level (academic / vocational level equivalent)*

No formal qualificationsNon UK where level is not knownEntry level (Entry level Word Power / Number Power, Entry level Certificate in Adult literacy / Numeracy, Entry level English for Speakers of Other Languages (ESOL), Entry level Skills for Life, other Entry level qualificationsLevel 1 (Any GCSE/O-levels grades D-G or CSEs, 1 AS Level, Level 1 certificate in Adult Literacy / numeracy, Level 1 English for Speakers of Other Languages (ESOL), Level 1 Skills for Life, BTEC First Certificate, Foundation Diploma, GNVQ Foundation, NVQ Level 1, other Level 1 qualificationsFull Level 2 (Any combination of 5 or more GCSE/O-levels grade A*-C or CSE grade 1, 1 A level, 2 or 3 AS levels, Level 2 English for Speakers of Other Languages (ESOL), BTEC First Diploma, Higher Diploma, GNVQ Intermediate, NQV Level 2, other level 2 qualifications)Full Level 3 (2 or more A levels, 4 or more AS levels, AVCE Double Award, Baccalaureate (L2), BTEC National Award, EDEXCEL Advanced Diploma, National Diploma, Access to Higher Education, GNVQ Advanced, NVQ Level 3, other level 3 qualifications)Level 4 (Teaching Certificate, Higher Education Certificate, HNC, Nursing (SRN), NQV Level 4, other level 4 qualifications)Level 5 (Teaching Diploma including DTLLS, foundation degree, Higher Education Diploma, HND, Nursing Higher Diploma, GNVQ Level 5, NVQ Level 5, Other Higher level professional qualifications, other Level 5 or above qualifications)
If you hold a qualification which does not fit into one of the levels above, please write it below (Qualification Title, Level and Awarding Body Name);
6a. EMPLOYMENT STATUS ON FIRST DAY OF LEARNING

Please select your employment status as of the first day of your learning programme
Employed full-time (20+ hours per week)Employed part-time (16-19 hours per week)Employed part-time (less than 16 hours per week)Full-time education or trainingSelf-employedUnemployed - due to redundancyUnemployed - due to reason other than redundancyEconomically Inactive14-19 NEET
6b. LENGTH AND STATUS OF UNEMPLOYMENT
Less than 6 Months6-11 Months12-23 Months24-35 MonthsOver 36 Months
Are you currently

In paid employmentNot in paid employment and looking for workNot in paid employment and not looking for work
7. Benefit Status

Please tick the relevant option(s) if you are in receipt of the following state benefits
Job Seekers Allowance (JSA)Employment and Support Allowance - Work Related Activity Group (ESA - WRAG)Universal Credit - (earning either less than 16 times the national minimum wage / national living wage or £330 a month) and are determined by JCP as being one of the following groups; Work-Related Requirements Groups, Work Preparation Group or the Work-Focused Interview GroupI have been mandated to this trainingOther State Benefit (please state below)
If other state benefit, please state;
8. TO BE COMPLETED BY ALL STUDENTS
CRIMINAL CONVICTIONS. This part MUST be completed (please refer to 'Criminal Convictions' statement below before answering question). Do you have any criminal convictions?*

YesNo
Please select if any of the following categories apply to you;*

Veterans & Military LeaversSEND & NeurodiverseMigrant Workers50 years old or overNone of the above
PRIVACY STATEMENT. It is important that you read the information stated in the statements below before signing this form. I can confirm I have read the College Data Protection and Privacy Notice Statement below and through my enrolment process have given the following consent;*

Store and process information in accordance with the Data Protection Statement
Please tick below if you give consent to the following;

Whilst I am a student, take my photo and/or video image and use it in accordance with the College Digital Image PolicyContact my employer or welfare support agencies to support achievement of my programme
How did you hear about this course?*
If other, please specify below;
Tick any of the following boxes if you give your consent to be contacted;

About courses or learning opportunitiesFor surveys and researchBy postBy phoneBy email
Further information about use of and access to your personal data, and details of organisations with whom we regularly share data are avilable at: https://www.gov.uk/government/publications/esfa-privacy-notice
DECLARATION: I can confirm that i have read and agree to be bound by the College's Terms and Conditions, the Learning Agreement and Privacy Statement as set out below which I understand also includes conditions, rules and regulations contained in the other documents specified; all of which have been drawn to my attention. I also confirm that to the best of my knowledge this programme does not duplicate any prior learning I have undertaken.
SIGNATURE:*

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9. Upload Documentation
Upload proof of I.D. (driving license, passport or birth certificate)*

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Proof of address (a statement or utility bill with your name and address on)*

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If you are not a UK citizen, please upload relevant visas (BRP and residential share code)

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If you are not a UK citizen, please upload proof of your right to work in the UK

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Universal Credit Statement

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Learning Agreement
• I confirm that all of the information given is correct.
• I have received assessment and guidance to assist in my choice of programme.
• I am satisfied that I fully understand the entry and programme requirements and will have the opportunity to receive advice about the learning
opportunities and any financial support available to me.
• I agree to make myself familiar with and abide by the regulations of Chelmsford College (www.chelmsford.ac.uk)
• I understand that if I have declared false information the College may take action against me to reclaim the tuition fees and any support costs provided.
• I accept responsibility for the payments of any fees due.
• I understand that if I am paying by instalments, it is my responsibilty to ensure that the payment schedule is adhered to.
• I am aware that fees are non-refundable unless otherwise stated/
• I agree to work towards my qualifications and submit assessments (where appropriate).
• I understand that if my programme is Agency funded may be part funded by the European Social Fund (ESF).
• I understand that if my programme is sponsored, my employer (upon request) can be given details of my attendance and progress.
• (Under 18 only) I agree that the College may contact my parents or guardian over concerns relating to my academic performance, attendance, punctuality
or behaviour.

Criminal Convictions
If you do not tick either the ‘Yes’ or ‘No’ box overleaf we will contact you to get this information and this will delay your enrolment.
You must tick yes if you have a conviction unless it is:

• A motoring offence that you received a fine or three penalty points for

Or

• A spent sentence (as defined by the Rehabilitation of Offenders Act 1974).

Please be aware that for certain courses, particularly in teaching, health and social care you must tell us about ANY criminal conviction(s), including spent
sentences and cautions. If you are serving a prison sentence you must tick the ‘Yes’ box. If you are convicted of a criminal offence, after you have enrolled, you
MUST let us know immediately. If you are not sure whether to tell us about a previous conviction you should get more advice from your Citizens’ Advice Bureau
or speak to our Student Information Centre.

Unique Learner Number
The ULN is a unique 10-digit number, and most learners aged 14+ have one. It is designed to work with your Personal Learning Record (PLR), helping to give you
proof of your learning and achievements from the age of 16 onwards.
The Education and Skills Funding Agency (ESFA), an executive agency of the Department for Eduaction (DfE), creates and holds the Unique Learner Numbers to
enable effective management of information to fulfil the functions of the DfE. This has been overseen and agreed with the Information Commissioner’s Office.
To this extent, the processing does not require an individual’s consent under the relevant Data Protection legislation.
The ULN is mandatory for all Learners aged 14+, or those who are in, or will be in, receipt of a diploma qualification. ULNs are also mandatory for learners in
England funded by the Education and Skills Funding Agency. To understand more about how your data is collected and used please visit:
https://www.gov.uk/government/publications/lrs-privacy-notices

Privacy Statement
I understand my personal information will be used by the college, Essex County Council, 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. 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

DfE Helpline

03700 002288

Please use the above number in case of whistleblowing and complaints
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Green Skills Retrofit Skills Bootcamp Enrolment Form

1. PERSONAL DETAILS

Address

Emergency Contact

2. YOUR CHOICE OF PROGRAMME

3. INFORMATION TO ASSESS YOUR ELIGIBILITY

4. EQUAL OPPORTUNITIES

5. PRIOR ATTAINMENT

6a. EMPLOYMENT STATUS ON FIRST DAY OF LEARNING

6b. LENGTH AND STATUS OF UNEMPLOYMENT

7. Benefit Status

8. TO BE COMPLETED BY ALL STUDENTS

9. Upload Documentation