Workplace Learning Enrolment & Data Capture Form (Start)
L03 Learner Reference Number
Box A
(Change of
Circumstance)
L01 Provider Number (UPIN)
1
0
8
4
9
L46 UK Provider Reference No
L45 Unique Learner Number
5
Section 1 – Learner Information (Please complete in BLOCK CAPITALS using Black Ink)
L09. Learner’s
Surname
L26. NI Number
L10. Learner’s
Forenames
L11. Date of
Birth
L17. Home
Postcode
L13. Sex
1
(M or F)
9
Title
(of Permanent Address Prior to enrolment)
L12. Ethnicity
L18. Home Address
L19.
L24. Country
of Domicile
L20.
L21.
Email
L22. Current
Postcode
L23. Telephone
Number
XF
Section 2 – Learning Difficulties/Disabilities and Employment Status
L14. Does the learner consider himself/ herself to have learning difficulty, disability or health problem?
(Enter 1 for ‘Yes’, 2 for ‘No’ or 9 for ‘No information provided by the learner’)
L15. If the learner has identified a Disability or Health Problem, please record the main disability
L16. If the learner has identified a Learning Disability or Difficulty, please record the main learning difficulty
L34. Learner Support Reasons
L37. Employment status on First
Day of Learning
9
9
0
1
9
9
9
9
9
9
L36. Status on Day Prior to Learning
0
0
L47. Current Employment Status
0
1
Refer to ILR Specification for codes
L48. Date Employment Status
Changed
2
0
Section 3 – Prior Attainment Level
The Workplace Learning service is designed to raise the skill levels of people to benefit themselves, employers and the wider
community. The Government chooses to prioritise its investment in those employees and volunteers without the equivalent of 5
GCSE’s (Grades A-C) already except where flexibilities exist regarding additional qualifications. Please tell us about all of your existing
qualifications. This list is not exhaustive.
School/College Qualifications
5 GCSE’s (Grades A-C) or O Levels
5 CSE Grade 1’s
1 or more A Level
2 AS Levels
Redbridge College – MIS
Enrolment Form (Start)
Vocational (work related) Qualifications BEC
General Certificate/ Diploma with Credit
st
HND/HNC/Edexcel/BTEC 1 Diploma or Higher
C&G Higher Operative or Craft/GNVQ Intermediate or Higher
NVQ Level 2, 3 or 4/Access Course
Version 1 June 2011
Workplace Learning Enrolment & Data Capture Form
(Start)
Learner’s Names
A03 Learner
Reference Number
Box A
(Change of Circumstance)
Prior Qualifications
Please indicate what qualifications you have completed in the past. Where you have no previous qualifications please state ‘None’.
Details of Qualification completed or
Date Qualification completed (date or year if
currently undertaking ( for example – Title, Module
exact date unknown)
Names, Awarding Body, Institution)
Level Achieved ( e.g. grade - A, B, C, L1, L2,
Intermediate, Advanced)
I confirm that the information given above is the highest qualification I have achieved prior to the start of my new qualification.
Learner Signature ____________________________________________________________
Highest and Additional
Qualifications
Highest Qualification:
Additional Qualification:
L35. Confirm Prior Attainment Level
Section 4 – Eligibility for Workplace Learning
Please tick if applicable
Yes
No
Yes
No
I can confirm that I am Employed and have a Contract of Employment.
I am Self Employed (since ……………………………… month/year) and I have registered myself employment with the HM
Revenue and Customs.
I can confirm that I am a Volunteer and receive no payment for the work undertaken other than incurred expenses where
payable.
I am NOT currently on the New Deal Programme or any other government funded training.
Section 5 – Residency Criteria
Please tick if applicable
I am normally and lawfully resident in the UK and Islands (this is, including the Channel Islands and the Isle of Man), or any EU
Country and have been for the last 3 years. This does not include persons with time-limited leave to remain where this does not
extend to the planned end date of the proposed learning aim of study; OR
I have not been resident in the UK but I fulfil the residency criteria and have provided the required evidence to confirm my
status, please detail below.
If ‘NO’, please give details of your circumstances below in order that your eligibility for participation in this programme can be confirmed:
Evidence ( Proof of Residency – Home Office Papers,
Details of Circumstances
Redbridge College – MIS
Immigration and Nationality
Departmental Letter, Passport etc)
Enrolment Form (Start)
Version 1 June 2011
Workplace Learning Enrolment & Data Capture Form
(Start)
Learner’s Names
A 03 Learner
Reference Number
Box A
(Change of Circumstance)
Section 6 – Confirmation of Information, Advice and Guidance, Induction and Individual Learning Plan
I can confirm I have taken part in the following with my Training Provider (please tick YES or NO for each statement)
Yes
No
1. An information and advice session to help me choose the right course for me:
2. I have been given the option of having a confidential advice session:
3. An assessment of my current Maths and English skills and advice on how I can up-date these :
(not mandatory if undertaking SME units/ thin qualifications)
4. An assessment of my current work skills and those I need to develop in my job:
5. A structured induction to my Workplace Learning programme:
6. Development of an Individual Learning Plan:
7. A discussion on options available including Apprenticeships has taken place:
8. A discussion of my initial assessment results with me:
Section 7 – Employer Details
Employer Name
Contact Name
Telephone
Number
No of Site
Employees
Section 8 – Learning Aim & Funding Details
A04. Data Set
Identifier Code
3
0
A09. Learning Aim
Reference
A10. Funding
Model
4
5
A11. Sources of
Funding
1
0
A70. Contracting
organisation code
S F
A15. Programme Type
9
9
A16. Programme
Entry Route
0
0
A26. Framework
Code
0
0
A53. Additional
Learning/ Social Needs
9
7
A51a. Proportion of
Funding Remaining
G L
A27. Learning
Start Date
2
9
9
0
2
0
A71. Reason for Full/CoFunding of Learning Aim
A69. Eligibility for
enhanced ER funding
9
9
A59. Planned Credit
Value (QCF learning aims only)
A18. Main
Delivery Method
2
4
A46. National Learning
Aim Monitoring
9
9
A63. National Skills
Academy
9
9
0
0
0
0
0
A44. Employer
Identifier
A45. Workplace
Location Postcode
A22. Franchise
and partnership
delivery provider
number
(UKPRN)
A64. Planned group based hours
Redbridge College – MIS
9
A28. Planned
End Date
0
A23. Delivery
Postcode Location
A49. Special
Projects and Pilots
5
9
9
9
9
A65. Planned oneto-one contact hours
Enrolment Form (Start)
Version 1 June 2011
Workplace Learning Enrolment & Data Capture Form
(Start)
Learner’s Names
A 03 Learner
Reference Number
Box A
(Change of Circumstance)
A61. Project Dossier No
A62. Local Project No
A66. Employment Status on day
before starting aim
0
A67. Length of unemployment
before starting ESF project
1
9
9
Section 9 – Special Monitoring Data
L40. National Learner Monitoring
L41. Local Learner Monitoring
L42. Provider specified Learner Data
A47. Local Learning Aim Monitoring
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
A48. Provider Specified Learning Aim Data
Section 10 – Declaration
Learner
‘I confirm that all of the personal information on this form is correct and I declare that I have correctly identified my prior qualifications. I have a contract of
employment (where applicable) and I fulfil the residency regulations for the Skills Funding Agency in England. I understand that if I have declared false
information the provider may take action against me to reclaim the tuition fees and any support costs provided’.
Learner Signature
Date
Employer
‘I confirm that, to the best of my knowledge, the information on this form is correct and that the learner is undertaking the appropriate qualification aim(s).
If the above named learner is employed by me, I declare that they have a contract of employment.
Employer Signature
Date
Provider
‘I confirm that information on this form is correct and I declare that I have supported the learner in the completion of this document and to the best of my
knowledge, the above named learner is eligible to enter Workplace Learning. I have seen evidence to support the residency criteria (where applicable)’.
Provider Signature
Date
This course is being delivered by Kiara College for Redbridge College.
How We Use Your Personal Information
The personal information you provide is passed to the Chief Executive of Skills Funding (“the Agency”) and, when needed , the Young People’s
Learning Agency for England (“the YPLA”) to meet legal duties under the Apprenticeships, Skills, Children and Learning Act 2009, and for the
Agency’s Learning Records Service (LRS) to create and maintain a unique learner number (ULN). The information you provide may be shared with
other partner organisations for purposes relating to education or training. Further information about use of and access to your personal data, and
details of partner organisations are available at:
http://skillsfundingagency.bis.gov.uk/privacy.htm
http:// www.ypla.gov.uk/privacy.htm
http://www.learningrecordsservice.org.uk/documentlibrary/documents/Code+of+Practice+for+Sharing+of+Personal+Information.htm
Tick any of the
following boxes if
you do not wish to
be contacted:
Redbridge College – MIS
About courses or
learning opportunities
For surveys
and research
Enrolment Form (Start)
By phone
By email
By post
Version 1 June 2011