Enrolment Form

2024-25
INFORMATION FOR CUSTOMERS
If you would like any part of this document explained, translated or provided in another format such as large print, audio or Braille, please contact Advice and
Admissions on 0800 612 6008. Please note our website has accessibility functions, allowing you to adjust the size of the text and colour of the background.

1. PERSONAL DETAILS Please complete all of the unshaded sections in black ink and BLOCK CAPITALS

Emergency contacts – Primary (to be completed by all students)

OFFICE USE Student ID no: 2 4 0 3 7 5 2 8 (if you are under 18 years of age, please give parent/guardian details)

Title: Mr Mrs Miss Ms Mx Other Name Massi

Relationship Friend
Sex: Male Female
Telephone
Gender identity: Male Female Prefer not to say Other
Mobile 07404319492
Preferred pronoun: he/him she/her they/them he/they Email
she/they
Is emergency contact an English Speaker? Yes No
Legal surname Khan Emergency contact – Secondary
Legal first name(s) Inam
Name
Preferred surname
Relationship
Preferred first name
Telephone
Date of birth 1 3 / 0 5 / 0 0 Age on 31st August 2024 2 4
Mobile
Home address 563 Stratford Road Email

Is emergency contact an English Speaker? Yes No

Postcode B 1 1 — 4 L P
Previous postcode if at above address for less than 3 years Are you in local authority care or a care leaver?

Telephone Yes No Prefer not to say

Mobile 07466152258 Are you a young carer? Yes No Prefer not to say
Email [email protected]
(Please note: we may on occasions contact you by text)
Criminal convictions This question MUST be completed
Do you have any criminal convictions? Yes No
Correspondence address if different You must tick yes if you have any unspent criminal convictions (as defined by the Rehabilitation
of Offenders Act 1974). Offences attracting sentences of 30 months imprisonment or more
are never spent and therefore must always be declared. If you are enrolling to a programme
Postcode involving teaching, health or social work which requires working with children or vulnerable
adults, you have a separate additional obligation to tell us about any criminal convictions,
Telephone including spent convictions, verbal cautions and bind-over orders. If you have been convicted of
a criminal offence after you have enrolled, you MUST tell us immediately.

2. YOUR CHOICE OF PROGRAMME

Programme/Course code Instance Group Programme/Course title Start date Expected end date

Add5 - A voluntary £5 contribution which goes into teaching, learning and Checked by:
enhancing students’ educational experience. To opt in, please tick here
Have any qualifications above been completed in part (e.g. award already completed when student is enrolling to a certificate or diploma in the same subject)?
Course code: Funding adjustment:
ESOL/FS/Digital skills
initial assessment results

3. INFORMATION TO ASSESS YOUR STUDENT STATUS Please complete the following section carefully and with full details

What is your nationality? Please state here

(a) Have you lived in the UK for the last 3 years? Yes No If no, have you lived in the EU for the past 3 years? Yes No
(b) In which country do you normally live?
What date did you enter the UK? / / Which country did you live in before coming into the UK?
4. EQUALITY AND DIVERSITY We are committed to equality and diversity. To help us monitor our policy, please complete the following:

Ethnicity Disabilities/learning difficulties

White
The information you supply here will be used to identify any support needs and will be kept
31 English / Welsh / Scottish / Northern Irish / British confidential.
32 Irish If you would prefer to discuss your support needs in private, please tick here and a
33 Gypsy or Irish Traveller member of our support team will contact you. Alternatively, please mark the box(es) which
describes your disability/learning difficulty.
34 Any other white background
No disabilities/learning difficulties 15 Asperger syndrome
Mixed / Multiple ethnic group
98 Prefer not to say 97 Other disability (please state)
35 White and black Caribbean
4 Vision impairment ______________________________
36 White and black African
37 White and Asian 5 Hearing impairment
6 Disability affecting mobility 17 Speech, language and
38 Any other mixed / Multiple ethnic background
communication needs
18 Down Syndrome
Asian / Asian British 10 Moderate learning difficulty
93 Other physical disability
39 Indian 11 Severe learning difficulty
40 Pakistani 95 Other medical condition, eg epilepsy,
asthma 12 Dyslexia
41 Bangladeshi
8 Social and emotional difficulties 13 Dyscalculia
42 Chinese
9 Mental health difficulty 94 Other specific learning difficulty
43 Any other Asian background
16 Temporary disability after illness or 14 Autistic spectrum disorder
Black / African / Caribbean / Black British
accident 96 Other learning disabilities
44 African
7 Profound complex disabilities
45 Caribbean
46 Any other black / African / Caribbean background
Please indicate which number you consider to be your main disability ______
Other
47 Arab Do you have an Education, Health and Care Plan? Yes No
98 Any other ethnic group

5. EMPLOYMENT DETAILS To be completed by all students

Please tick the box which best describes your employment status: Employed (move to Section A) Self-employed (move to Section A)
Unemployed/Not employed (move to Section B) Made redundant (move to section B) In full-time education (move to Section B)

Section A
Are you employed? 0-10 hours per week 11-20 hours per week 21-30 hours per week 31+ hours per week

Are your earnings from employment or self-employment below £25,000 per year before tax? Yes No

Section B Please tick all that apply Are you: Looking for work/Available to start work Not looking for work/Not available to start work

How long have you been unemployed? 0-5 months 6-11 months 12-23 months 24-35 months 36 months or over

Are you in receipt of any of the following benefits?

Universal Credit Job Seekers Allowance Employment Support Allowance

6. FEES You can pay by debit or credit card, by cheque (made payable to Activate Learning), or in cash if paying in person. If you want to pay in
instalments, speak to an advisor about our instalment scheme.

For fully funded learners only:

I am a fully funded learner but wish to keep the materials from my course and agree to pay the material fees associated with this course.

Fee remission evidence provided Checked by:

Please indicate who will be paying your fees:

Student Employer (please provide authorisation on company headed paper) Advanced Learner Loan

Training agent Training agency name

7. PRIOR ATTAINMENT (to be completed by all students)

GCSE grade C(4) or above achieved by end of year 11: in maths Yes No in English Language Yes No

Highest GCSE English language/literature grade: Validated by:

Highest GCSE Maths grade: Validated by:
Highest other English qualification and grade: Validated by:
Highest other maths qualification and grade: Validated by:

Please tick the description of qualifications that best applies to you. For any non-UK qualifications, tick the equivalent Level.

Level Examples of academic/vocational level equivalent Tick box

No formal qualifications
Other qualifications
where level is not known
Entry 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 qualifications

Level 1 Any GCSE/O-Levels grades D-G/3-1 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 qualifications

Level 2 Vocational and technical qualifications at level 2 (not on the level 2 and level 3 legal entitlement list), Functional skills at level 2, ESOL (skills for life),
Technical Awards in the Key Stage 4 Performance Tables, Performing Arts Graded Examination qualifications

Full Level 2 Any combination of 5 or more GCSE/O-Levels grade A*-C/9-4 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, NVQ Level 2, other Level 2 qualifications

Level 3 Vocational and technical qualifications at level 3 (not on the level 2 and level 3 legal entitlement list), Core maths, Technical qualifications
(part of T levels), Components of international baccalaureate, Performing Arts Graded Examination qualifications, Pre U 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), NVQ 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

Level 6 Professional diploma/ certificate/ award, City & Guilds Graduateship, Degree with honours

Level 7 Advanced professional diploma/ certificate/ award, Masters degree, City & Guilds membership

16-18 year olds only

Last school/college attended:

Are you studying at any other academic institution this academic year? Yes No

8. LEARNING AGREEMENT
How we use your personal information
Activate Learning group will collect your personal data under GDPR Article 6b (Contract), 6c (Legal Obligation), 6e (Public Task), 6f (Legitimate Interests) and 9j (Statistical
Purposes). We need to process data so we can provide you with the highest standards of education and training we are able to give, to meet legal obligations and in order
for us to carry out our public task. We will use your data to:
• Support learning, monitor and report on student progress and keep you informed about issues affecting and related to your studies
• Provide appropriate guidance and pastoral support and keep you safe
• Assess and improve the quality and relevance of our services, including conducting research to support improvement
• Comply with the law and our contractual obligations, including reporting on your destination after studying with us
• Keep you informed of relevant services and promotions, form an alumni community and record and showcase our work
We may contact you from time to time, on the basis of Legitimate Interests, to ask for your opinions or let you know about products and services relevant to your previous
enrolments or purchases, and you have the right, at any time, to opt-out of our communications using the links in our emails.
We would like to tell you more about other courses, services and products we offer; to consent to being contacted about these opportunities, please tick the boxes below
to indicate your consent and your preferred method of contact:
By post By phone By email
We collect parent/carer/emergency contact details for all students under GDPR Article 6c (Legal Obligation) and we will inform them that we hold their information. For
students who are aged under 18 on 31st August 2024 under Article 6b (Contract) we will use this to update your contacts on your educational progress and behaviour. If
you do not wish us to share your information in this way, please write to the Student Support Director to let them know.
You have a responsibility to ensure that personal data provided to the group is accurate and up to date. You are entitled to exercise certain rights related to your personal
data; if you wish to exercise any of your rights in this respect, please visit our website or contact [email protected].
Further details are available at www.activatelearning.ac.uk/about-us/policies-and-procedures/privacy-and-data-protection and from reception.
ESFA Privacy Notice:
This privacy notice is issued by the Education and Skills Funding Agency (ESFA) on behalf of the Secretary of State for the Department of Education (DfE) to inform
learners about the Individualised Learner Record (ILR) and how their personal information is used in the ILR. Your personal information is used by the DfE to exercise our
functions under article 6(1)(e) of the UK GDPR and to meet our statutory responsibilities, including under the Apprenticeships, Skills, Children and Learning Act 2009.
Our lawful basis for using your special category personal data is covered under Substantial Public Interest based in law (Article 9(2)(g)) of GDPR legislation. This
processing is under Section 54 of the Further and Higher Education Act (1992).

The ILR collects data about learners and learning undertaken. Publicly funded colleges, training organisations, local authorities, and employers (FE providers) must collect
and return the data to the ESFA each year under the terms of a funding agreement, contract or grant agreement. It helps ensure that public money distributed through the
ESFA is being spent in line with government targets. It is also used for education, training, employment, and well-being purposes, including research.

For more information about how your personal data is used and your individual rights, please see the DfE Personal Information Charter (https://www.gov.uk/government/
organisations/department-for-education/about/personal-information-charter) and the DfE Privacy Notice (https://www.gov.uk/government/publications/privacy-notice-for-
key-stage-5-and-adult-education)

If you would like to get in touch with us or request a copy of the personal information DfE holds about you, you can contact the DfE in the following ways:

- Using our online contact form https://www.gov.uk/government/organisations/department-for-

education/about/personal-information-charter
- By telephoning the DfE Helpline on 0370 000 2288
- Or in writing to: Data Protection Officer, Department for Education (B2.28), 7 & 8 Wellington Place, Wellington Street, Leeds, LS1 4AW

If you are unhappy with how we have used your personal data, you can complain to the Information Commissioner’s Office (ICO) at:
Wycliffe House, Water Lane, Wilmslow, Cheshire, SK9 5AF. You can also call their helpline on 0303 123 1113 or visit https://www.ico.org.uk
Learner Agreement
I understand that by signing this enrolment form I agree to the following:
- Keep to the Code of Conduct, including wearing a lanyard at all times while on campus.
- Commit to the Activate Learning Standards of Behaviour.
I understand that if I do not, I will face disciplinary action and maybe permanently excluded.
Fees
I accept the responsibility for the payment of any fees due and understand that if I am paying by instalments, I must meet the instalment plan. I am aware that fees are non-
refundable unless otherwise stated. A full copy of the fees policy can be obtained from our website. I understand that if I have declared incorrect information, relating to my
fee assessment, the group may take action against me to reclaim the tuition fees and any support costs provided. I understand that if my programme is sponsored, my
employer and/or training agent can be given details of my attendance and progress.
Insurance and group’s liability
I shall insure my personal belongings before starting on the programme. I accept that the group does not accept responsibility, and expressly excludes liability for;
• any loss or damage to my property, including damage to any motor vehicle or cycle while on group property, my employer’s and or training agent’s premises, unless
caused by negligence of the group or its employees;
• death or any personal injury suffered by me, unless caused by negligence of the group or its employees;
Although the group will try to ensure that the college computer equipment and software I use has reasonable security measures, my use of such computer equipment
and any software shall be at my own risk. The group shall not be liable for loss or damage I suffer as a result of the use of any computer equipment or software provider or
made available by the group, including any contamination of software or loss of files
Declaration
I am satisfied that I fully understand the entry and programme requirements and have received assessment and guidance to assist in my choice of programme and will
have the opportunity to receive advice about financial support available to me
Agreement
I have read and agree with the terms and conditions

Learner signature: Date: / /

Staff name: Signature: Date: / /

For staff use only

Identification checked by:___________________ Passport Visa/National ID card Birth certificate Driving licence NI card/letter
Other:_________________
Eligibility: Home Overseas Right to Study checked by:________________________________

Waiver code: ______________________ Total fees due: ______________________ Funding level: Fully funded Co-funded Non-funded

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