START WELL PROGRAMME ENROLMENT FORM (MASTER)

Name

First NameLast Name

Preferred Name

Date of Birth

Contact Telephone Number

Contact Email Address

Who is completing this form?

If you are completing on behalf of/referring the learner, please confirm your name and relationship to learner

First NameLast Name

Relationship to learner

Course Name

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:

Please specify disability or medical condition not specified 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;

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;

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:

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 agree to make myself familiar with and abide by the regulations of Chelmsford College (www.chelmsford.ac.uk)
• 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.

Privacy Statement
I understand my personal information will be used by the college, 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

Start Well Enrolment Form

1. PERSONAL DETAILS

2. YOUR CHOICE OF PROGRAMME

4. EQUAL OPPORTUNITIES