Application Form
Office Use only:- Programme:
Start Date:
PED:
Pathway (SFA/EFA):
TA:
1 Personal Details
Surname (Family
Name)
Female 
Forename(s)
(First/given names)
Date of Birth
Nationality
Age on
31/08/2014
Male 
Address
Post Code
Have you lived here for 3 years or more? Yes  No  If no, what was your previous postcode?
Home Telephone
number
Mobile Number
e-mail
National
insurance Number
Emergency Contact Details
Name
Relationship
to you
Contact Number
2 Your Course
Please indicate your first course choice or career interest:-
Where did you hear about us:
Apprenticeship Vacancy System
Employer
Facebook or Twitter
Leaflet or Flyer
Search Engine (Google)
School / College or Connexions
Word of mouth
YMCA Training Website
Other:
3 Residency / Eligibility Details
You must produce evidence of your residency before commencing any course with YMCA Training
Have you been a resident in the UK or EEA for the last 3 years
Yes 
If no, has your spouse or another family member been a resident in
Yes 
the UK or EEA for the last 3 years?
Have you been granted any of the following?
Humanitarian Protection

Refugee Status

Exceptional Leave to Enter or Remain

Application Registration Card

Indefinite Leave to Enter of Remain

Standard Application

Discretionary Leave

Do you hold any of the following documents
UK/EU/EEA Passport
Yes  No 
UK/EU/EEA Birth Certificate
Yes  No 
Are you currently in receipt of any state benefits?
YES  NO 
If YES please give details:(e.g JSA, Universal Credit; ESA WRAG)
Do you receive free school meals at school? YES  NO 
4 About your employment / Unemployment
Are you currently in contracted employment
If YES - Name of Employer:If YES – How many contracted hours do you work per week:If NO – How long have you been unemployed:-
YES  NO 
Telephone No :-
No 
No 
5 Ethnicity (please tick)
White British, English, Scottish,
White & Black African

Welsh, Northern Irish

White Irish

White & Black Caribbean 
Gypsy or Irish Traveller

White & Asian

Any Other white background

Any other ethnic group (please state):
Black African

Arab

Black Caribbean

Bangladeshi
Chinese
Indian
Pakistani




Any other black/African/
Caribbean background 
6 Health / Learning Difficulties / Disabilities
Do you consider yourself to have any medical conditions, learning difficulties or disabilities that could affect your training?
Yes  No 
If YES please describe:
Do you have a Learning Difficulty Assessment or Section 139A Agreement in place? Yes  No 
Do you have any specific requirements or do you wish any adjustments to be made for you whilst on programme at YMCA
training?
Yes  No 
If YES please describe:
Do you have an Education Health Care Plan in place? Yes 
No 
7 Previous Education (include the highest level of qualification)
What is the highest level of qualification? Tick the first box that applies to you.
No Qualifications
 Entry Level 3 or equivalent

Full Level 1 or equivalent 
Full Level 2 or equivalent  Level 3 or equivalent

Level 4 or above

All Qualifications – You will be asked to provide evidence of all relevant grades
Subjects Taken
Level: GCSE / A Level / NVQ /
Year
Result / Grade
Level 2 / Functional skill etc.
Do you have GCSE English
Language grade C or above?
If Yes, did you achieve this
by the end of year 11?
Yes 
No 
Yes 
No 
Do you have GCSE Maths
grade C or above?
If Yes, did you achieve this
by the end of year 11?
(Office Use)
Evidence Verified







Yes 
No 
Yes 
No 
8 How we use your personal information
The personal information you provide is passed to the Chief Executive of the Skills Funding Agency (“the Agency”) and, when
needed, the Department for Education, including the Education Funding Agency to meet legal responsibilities 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 organisations for education,
training and employment–related purposes, including for research. Further information about use of and access to your personal
data, and details of organisations with whom we regularly share data are available at:
https://www.gov.uk/government/publications/sfa-privacy-notice
From time to time, YMCA Training may have to share some of the information you have provided on this form with a third party,
or with others within our organisation. Examples of this may be where we have to confirm some of the details with your referral
agency, or if we need to discuss your application with your employer or with your allocated Training Adviser. We would never
share your information without good reason.
If you would prefer NOT to be contacted by other agencies please tick below:Courses and Learning opportunities:- By Post 
By E-mail 
By Phone 
For Surveys and Research
:- By Post 
By E-mail 
By Phone 
9 Declaration
I can confirm that to the best of my knowledge I have provided all the necessary information to YMCA Training in order for them to confirm my
eligibility for funding and that the information supplied on this form is true. I give permission for my personal information to be shared when
needed as stated.
Applicant Signature_____________________________________________ Date__________________________________________
Please return your completed form to: 209 Whapload Road, Lowestoft, Suffolk. NR32 1UL