Save & Continue Later Clear Form Adult Learning 1About You2A Little More About You3Where You Live4Guidance Message5In An Emergency6Nationality7Guidance Message8Student Support9Employment10Guidance Message11Criminal Disclosure12Education So Far13Identification14Assessment15Payments16Privacy Policy17Guidance Message18Declaration19Before You Submit This Form20Uploads21 About You The details provided will be used on your College ID Card and all Exam certificates - any Amendments will incur fees.This field is hidden when viewing the formEnrolAPIThis field is hidden when viewing the formEnrol IDTitle*Please selectMrMissMrsMsGender* Male Female Forename(s) (Given Names)*Surname (Family Name)*Known AsDate of Birth* Day Month Year This field is hidden when viewing the formHow old will you be on the 31st August 2021National Insurance Number* I don't know this informationThis field is hidden when viewing the formAge A Little More About YouMobile Number*Telephone NumberEmail Address* Enter Email Confirm Email What is your intended destination after completing your planned course?*Please SelectApprenticeshipEmployment19+ Only Enhance career19+ Only Further learning19+ Only Leisure learningNext level of courseUniversityUnknown Where You LiveHouse Name or Number & 1st Line of your Address*2nd Line of your AddressTown / City*County*Postcode*How long have you lived at this address?*Which of the following statements best describes your current household living situation? (one or more may apply)* No member of the household in which I live (including myself) is employed The household that I live in includes only one adult (aged 18 or over) There are one or more dependent children (aged 0 to 17 or 18-24 years if full-time students or inactive) in the household None of these statements apply I prefer not to say Personal Details Done! That's the personal details section completed, and you're nearly a quarter of the way through already. If you do have any questions or you need some support completing the enrolment form, then please get in touch. Click on the button below and share your contact details and someone will be in touch with you, within 48 hours. Request a Callback In An Emergency We require the contact information for two people the College should get in touch with in case of an emergency. Emergency Contact 1Title*Please SelectMrMrsMissMsFirst Name*Last Name*What relationship is this person to you?*Please SelectAuntBrotherFatherGrandadGrandmaHusbandMotherNot KnownPartnerSisterSocial Worker/Outside AgencyUncleWifeOtherDo you live with this person?* Yes No House Name or Number & 1st Line of their Address*2nd Line of your AddressTown / City*County*Postcode*What is their mobile telephone number?*What is their home telephone number?What is their email address?* Would you like to provide a second emergency contact?* Yes No Emergency Contact 2Title*Please SelectMrMrsMissMsFirst Name*Last Name*What relationship is this person to you?*Please SelectAuntBrotherFatherGrandadGrandmaHusbandMotherNot KnownPartnerSisterSocial Worker/Outside AgencyUncleWifeOtherDo you live with this person?* Yes No House Name or Number & 1st Line of their Address*2nd Line of your AddressTown / City*County*Postcode*What is their mobile telephone number?*What is their home telephone number?What is their email address?* NationalityHave you been resident in the UK for the last 3 years prior to the intended start of your course?* Yes No What is your normal country of residence?*Select CountryAndorraUnited Arab EmiratesAfghanistanAntigua And BarbudaAnguillaAlbaniaArmeniaNetherlands AntillesAngolaArgentinaAmerican SamoaAustriaAustraliaArubaÅland IslandsAzerbaijanBosnia And HerzegovinaBarbadosBangladeshBelgiumBurkinaBulgariaBahrainBurundiBeninSt BarthélemyBermudaBruneiBoliviaBonaire, Sint Eustatius and SabaBrazilBahamas, TheBhutanBotswanaBelarusBelizeCanadaCocos (Keeling) IslandsCongo (Democratic Republic)Central African RepublicCongoSwitzerlandIvory CoastCook IslandsChileCameroonChinaColombiaCosta RicaCubaCape VerdeChristmas IslandCzech RepublicGermanyDjiboutiDenmarkDominicaDominican RepublicAlgeriaEcuadorEstoniaEgyptWestern SaharaEritreaSpainEthiopiaEuropean Union Not Otherwise SpecifiedFinlandFijiFalkland IslandsMicronesiaFaroe IslandsFranceGabonGrenadaGeorgiaFrench GuianaGuernseyGhanaGibraltarGreenlandGambia, TheGuineaGuadeloupeEquatorial GuineaGreeceSouth Georgia And The South Sandwich IslandsGuatemalaGuamGuinea-BissauGuyanaHong Kong (special Administrative Region Of China)HondurasCroatiaHaitiHungaryCanary IslandsIndonesiaIrelandIsraelIsle Of ManIndiaIraqIranIcelandItalyJerseyJamaicaJordanJapanKenyaKyrgyzstanCambodiaKiribatiComorosSt Kitts And NevisKorea (north)Korea (south)KuwaitCayman IslandsKazakhstanLaosLebanonSt LuciaLiechtensteinSri LankaLiberiaLesothoLithuaniaLuxembourgLatviaLibyaMoroccoMonacoMoldovaMontenegroSt Martin (French Part)MadagascarMarshall IslandsMacedoniaMaliBurmaMongoliaMacao (special Administrative Region Of China)Northern Mariana IslandsMartiniqueMauritaniaMontserratMaltaMauritiusMaldivesMalawiMexicoMalaysiaMozambiqueNamibiaNigerNorfolk IslandNigeriaNicaraguaNetherlandsNorwayNepalNauruNiueNew ZealandOmanPanamaPeruFrench PolynesiaPapua New GuineaPhilippinesPakistanPolandSt Pierre And MiquelonPitcairn, Henderson, Ducie And Oeno IslandsPuerto RicoOccupied Palestinian TerritoriesPortugalPalauParaguayQatarKosovoRéunionRomaniaSerbiaRussiaRwandaSaudi ArabiaSolomon IslandsSeychellesSudanSwedenSingaporeSt Helena, Ascension and Tristan da CunhaSloveniaSvalbard And Jan MayenSlovakiaSierra LeoneSan MarinoSenegalSomaliaSurinamSao Tome And PrincipeEl SalvadorSint Maarten (Dutch Part)SyriaSwazilandTurks And Caicos IslandsChadTogoThailandTajikistanTokelauEast TimorTurkmenistanTunisiaTongaTurkeyTrinidad And TobagoTuvaluChina (Taiwan)TanzaniaUkraineUgandaUnited StatesUruguayUzbekistanVatican CitySt Vincent And The GrenadinesVenezuelaBritish Virgin IslandsUnited States Virgin IslandsVietnamVanuatuWallis And FutunaSamoaCyprus (European Union)Cyprus (Non-European Union)Cyprus Not Otherwise SpecifiedEnglandNorthern IrelandScotlandWalesUnited Kingdom Not Otherwise SpecifiedChannel Islands Not Otherwise SpecifiedEurope Not Otherwise SpecifiedAfrica Not Otherwise SpecifiedMiddle East Not Otherwise SpecifiedAsia (except Middle East) Not Otherwise SpecifiedNorth America Not Otherwise SpecifiedCentral America Not Otherwise SpecifiedSouth America Not Otherwise SpecifiedCaribbean Not Otherwise SpecifiedAntarctica And Oceania Not Otherwise SpecifiedYemenMayotteSouth AfricaZambiaZimbabweNot KnownYou will be asked to provide evidence of your residency status in the UK. This may include showing a member of staff your passport or immigration paperwork, by supplying one of the following documents, please indicate which documents you will be able to bring with you when you attend College.* Passport Residence Permit Supporting Letter of Residence Which of the following is the closest to your ethnic background?* Asian/Asian British Black/Black British Mixed White Other Not Provided Which of the following is the closest to your ethnic background?* Bangladeshi Chinese Indian Pakistani Any other Asian background Which of the following is the closest to your ethnic background?* African Caribbean Any other Black / African / Caribbean background Which of the following is the closest to your ethnic background?* White and Asian White and Black African White and Black Caribbean Any Other Mixed / multiple ethnic background Which of the following is the closest to your ethnic background?* English / Welsh / Scottish / Northern Irish / British Irish Gypsy or Irish Traveller Any Other White background Which of the following is the closest to your ethnic background?* Arab Any other ethnic group That’s 5 sections already completed! Don't forget, if you decide to stop completing this form, and you don't want your details being seen by others, click on the Clear Form button on the right-hand side of your screen, this will delete all the information you have added into the form so far. If you do have any questions or you need some support completing the enrolment form, then please get in touch. Click on the button below and share your contact details and someone will call you back within 48 hours. Request a Callback Student SupportDo you consider yourself to have a learning difficulty or disability?*Please SelectI have a learning difficulty or disabilityI have no learning difficulty or disabilityNo information providedPlease indicate your primary learning difficulty or disability*Please SelectVisual impairmentHearing impairmentDisability affecting mobilityProfound complex disabilitiesSocial and emotional difficultiesMental health difficultyModerate learning difficultySevere learning difficultyDyslexiaDyscalculiaAutism spectrum disorderAsperger's syndromeTemporary disability after illness (for example post-viral) or accidentSpeech, Language and Communication NeedsOther physical disabilityOther specific learning difficulty (e.g. Dyspraxia)Other medical condition (for example epilepsy, asthma, diabetes)Other learning difficultyOther disabilityPrefer not to sayNot providedPlease indicate any other learning difficilty or disabilityPlease SelectVisual impairmentHearing impairmentDisability affecting mobilityProfound complex disabilitiesSocial and emotional difficultiesMental health difficultyModerate learning difficultySevere learning difficultyDyslexiaDyscalculiaAutism spectrum disorderAsperger's syndromeTemporary disability after illness (for example post-viral) or accidentSpeech, Language and Communication NeedsOther physical disabilityOther specific learning difficulty (e.g. Dyspraxia)Other medical condition (for example epilepsy, asthma, diabetes)Other learning difficultyOther disabilityPrefer not to sayNot providedDo you require learning support at College?* Yes No Do you require exam access arrangements?* Yes No Do you have access to the Internet at home?* Yes No Do you have access to a computer or device, e.g. a laptop or tablet, to enable you to complete work at home?* Yes - My Own Yes - A shared device No EmploymentWhat will be your Employment Status on the first day of learning with us?* In Paid Employment Unemployed, looking for work and available to start work Unemployed, not looking for work and/or not available to start work Not Known/Not Provided How many hours do you work each week?* Learner is employed for 0 to 10 hours per week Learner is employed for 11 to 20 hours per week Learner is employed for 21 to 30 hours per week Learner is employed for 31+ hours per week Are you self-employed?* Yes No As you have indicated you are currently Unemployed:How many months have you been unemployed?*Please SelectLess than 6 months6-11 months12-23 months24-35 monthsOver 36 monthsAre you in receipt of any of the following benefits*Please SelectJob Seekers Allowance (JSA)Employment and Support Allowance - Work Related Activity Group (ESA WRAG)Another state benefitUniversal CreditI am currently not receiving any state benefits You're nearly done, you’re over halfway through. When you submit your enrolment form, the form will automatically be cleared, and don't worry, none of your personal information will be kept on your laptop, desktop, or mobile device. If you do have any questions or you need some support completing the enrolment form, then please get in touch. Click on the button below and share your contact details and someone will call you back within 48 hours. Request a Callback Criminal DisclosureDo you have any convictions, including offences committed outside of the UK?* Yes No Please note: If you are applying for a course leading to working with children under 18, vulnerable adults, social services, uniformed services, teacher training or the health service you should ask at the interview for advice as certain convictions may affect future employment in these areas. All students need to be aware of their duty to inform the Safeguarding Team of any criminal convictions (spent and unspent).As you have answered YES to having had a previous conviction, we will need to get in touch with you so you can fill out a Confidential Disclosure Form. Please continue to complete and submit your Enrolment form, and one of our team will be in touch with you soon. Education So FarWhat is your highest existing qualification*Please SelectEntry Level - Basic English/Maths/ESOLLevel 1 - GCSE Grades D-G / 1-3, or less than 5 GCSE’s A*-C / 4-9Level 2 - 5 or more GCSE’s A*-C / 4-9Full Level 2Level 3 - Level 3 Certificate / DiplomaFull Level 3Level 4 - HNC / Level 4 CertificateLevel 5 - HND / Foundation Degree / Level 5 CertificateLevel 6 - Bachelor’s DegreeLevel 7 and above - Masters Degree / DoctorateOther Qualification - Level not knownNot KnownNo Qualifications Identification You will need to supply proof of Identification and Address, originals of which you will need to bring with you when you start college Below are some examples of documents we can accept, please check the items you have available and could bring with you. We will remind you of these documents in an email.This field is hidden when viewing the formI will be bringing: Passport Driving Licence Letter with Name and Address Birth Certificate Bank Statement Wage slip Certificates I will be bringing: Passport Driving Licence Letter with Name and Address Birth Certificate Bank Statement Wage slip Certificates ASSESSMENT FOR FEES OR FEE WAIVER The following section consists of questions that are designed to see if you meet any criteria that may allow you to waive the fee for your course. You may have to supply evidence to the contrary and also sign a declaration following the submission of this form.Do you think you can claim a waiver for your course fees? (If, you are not sure, click yes here and answer the next question)* Yes No Is your course a Functional Skills or GCSE English or Maths Course?* Yes No SELF DECLARATION - GCSE ENGLISH & MATHSSELF DECLARATION - GCSE ENGLISH & MATHS* I declare that I do not already have a GCSE Grade C/Grade 4 or above in English Language or Maths*Will you be aged under 24 years old (at the start of your course) AND your chosen course is a Full Level 3 Course?* Yes No FIRST FULL LEVEL 3 (FL3) SELF DECLARATIONFIRST FULL LEVEL 3 (FL3) SELF DECLARATION* I declare that I do not already have a full level 3 (FL3) qualification or above. I am aged at least 19 but under 24 at the start of my course*Is your course a Full Level 2 Course, or a course leading to a Full Level 2 Course?* Yes No FIRST FULL LEVEL 2 SELF (FL2) DECLARATIONFIRST FULL LEVEL 2 SELF (FL2) DECLARATION* I declare that I do not already have a full level 2 (FL2) qualification or above. I am aged at least 19 but under 24 at the start of my course*Are you currently unemployed and / or claiming benefits?* Yes No BENEFITS AND INTENTION TO ENTER EMPLOYMENT DECLARATION I confirm that I am unemployed and in receipt of a relevant state benefit at the start of the course and that this is an ongoing claim and I declare it is my intention to enter employment after completing the course, skills and training provided by Kirklees College.benefitsdeclaration1* Council Tax Reduction (excluding single occupancy) Employment and Support Allowance (Income Related) Housing Benefit Income Support Unemployed person named on a joint claim for Working Tax Credit with a household income under £15,276 N/A - I am not currently receiving any of the above state benefits I confirm that I have been referred by the Job Centre to undertake a course at Kirklees College OR I am claiming one of the benefits listed below at the start of the course and that this is an ongoing claim.benefitsdeclaration2* Employment Support Allowance (ESA) Work Related Activity Group (WRAG) Jobseekers Allowance (JSA) (inc. those receiving National Insurance Credits only) Universal Credit and mandated (required) to undertake skills training - and accepted a “Claimant Commitment” N/A - I am not currently receiving any of the above state benefits Do you earn below £17,004.00 per year?* Yes No BENEFITS AND INTENTION TO ENTER EMPLOYMENT DECLARATIONBENEFITS AND INTENTION TO ENTER EMPLOYMENT DECLARATION* I confirm that I am in employment or self-employed and my annual gross income (before tax) is less than £17,004.00** Please check the box to confirm on the start date of your course, you will bring with you your latest wage slip from your current employer, this must be dated with 3 months of your course start date.** Please check the box to confirm on the start date of your course, you will bring with you your employment contract that states your monthly or annual gross (before tax) salary from your current employer.*From your answers above you initially appear to be eligible to have your course fee waived. Upon submission of this form you will be emailed a copy of the above enrollment and declarations you have made to which you will have to electronically sign. Simply follow the instruction in the email you receive. This may take up to 20 minutes to receive.This field is hidden when viewing the formFeeWaiverEligibile This field is hidden when viewing the formFeeWaiverNotEligibleThis field is hidden when viewing the formFeeWaiverNotEligible1From your answers on the previous page appears that you are not currently eligible for help with or having your course fees waived, and therefore your course must be paid for. Here are your following payment options. The cost for your [PS1] course will be [PS3] which is over a study term of [PS4] weeks.How would you like to pay the above course fee?* Full Payment Monthly Installment As you have selected to pay for your course in full, following submission of this form, you will be redirected to our secure payment gateway to pay for your course by credit or debit card in full. If you need time to arrange the funds for this payment, you can save and continue this enrolment later (see link below), so you don't lose your progress and just pick up from right here.As you have selected to pay for your course over monthly instalments, taking into account the value and term of your course, here are your monthly instalment plan options, please select one.This field is hidden when viewing the formAs you have selected to pay for your course over monthly instalments, taking into account the value and term of your course, here are your monthly instalment plan options, please select one. Your course fee of [PS3] paid over 2 months would be [calc2] per month Your course fee of [PS3] paid over 4 months would be [calc4] per month This field is hidden when viewing the formAs you have selected to pay for your course over monthly instalments, taking into account the value and term of your course, here are your monthly instalment plan options, please select one. Your course fee of [PS3] paid over 2 months would be [calc2] per month Your course fee of [PS3] paid over 4 months would be [calc4] per month Your course fee of [PS3] paid over 6 months would be [calc6] per month This field is hidden when viewing the formAs you have selected to pay for your course over monthly instalments, taking into account the value and term of your course, here are your monthly instalment plan options, please select one. Your course fee of [PS3] paid over 2 months would be [calc2] per month Your course fee of [PS3] paid over 4 months would be [calc4] per month Your course fee of [PS3] paid over 6 months would be [calc6] per month Your course fee of [PS3] paid over 8 months would be [calc8] per month If you need time to arrange the funds for this payment, you can save and continue this enrolment later (see link below), so you don't lose your progress and just pick up from right here.This field is hidden when viewing the formFirst Initial PaymentThis field is hidden when viewing the formSubsequest Monthly PaymentsThis field is hidden when viewing the formInstallment PlanThis field is hidden when viewing the formInstallmentPlanOptionThis field is hidden when viewing the formFullPaymentYour subsequent instalment payments should be deducted on which date?* 16th of the month (starting next month) 28th of the month (starting next month) Only 3 more sections left We do need you to take your time and read these sections carefully, making sure that all the information you have shared with us is correct. Don’t forget if you do have any questions or you need support completing the enrolment form, then get in touch, we are here to help. Simply click on the button below and share your contact details and someone will call you back within 48 hours. Request a Callback Privacy & Data Policy How we use your personal information 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). It is to inform learners how their personal information will be used by the DfE, the ESFA (an executive agency of the DfE) and any successor bodies to these organisations. It should be read alongside the ESFA Privacy Notice which can be found at:https://www.gov.uk/government/publications/esfa-privacy-notice If you would like: more information about how we process your personal data, or your data protection rights. to make a request about your information – for example to request a copy of your information or to ask for your information to be changed. to contact our Data Protection Officer You can contact us in the following ways if you would like to make a request: Using our secure online contact form, which can be found at: https://form.education.gov.uk/service/Contact_the_Department_for_Education Or in writing to: Emma Wharram Data Protection Officer Ministerial and Public Communications Division Department for Education Piccadilly Gate Store Street Manchester M1 2WD How We Use Your Personal Information and why we have it 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 may be used for education, training, employment and well-being related purposes, including for research. The DfE and the English European Social Fund (ESF) Managing Authority (or agents acting on their behalf) may contact you in order for them to carry out research and evaluation to inform the effectiveness of training. How long we will keep your personal data Your information will be securely destroyed in accordance with the ESFA’s retention and disposal schedule after it is no longer required for these purposes. How we share your personal data Your information may also be shared with other third parties for the above purposes, but only where the law allows it, and the sharing is in compliance with data protection legislation. Your data protection rights Under data protection law, you have rights including: Your right of access - You have the right to ask us for copies of your personal information. Your right to rectification - You have the right to ask us to rectify personal information you think is inaccurate. You also have the right to ask us to complete information you think is incomplete. Your right to erasure - You have the right to ask us to erase your personal information in certain circumstances. Your right to restriction of processing - You have the right to ask us to restrict the processing of your personal information in certain circumstances. Your right to object to processing - You have the right to object to the processing of your personal information in certain circumstances. Your right to data portability - You have the right to ask that we transfer the personal information you gave us to another organisation, or to you, in certain circumstances. You are not required to pay any charge for exercising your rights. If you make a request, we have one month to respond to you. How to withdraw consent You can agree to be contacted by other third parties by ticking any of the following boxes: About courses or learning opportunities For surveys and research By Post By Phone By EmailFurther 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 How to complain If you have any concerns about our use of your personal information, you can make a complaint to the Data Protection Officer at: Ministerial and Public Communications Division Department for Education Piccadilly Gate Store Street Manchester M1 2WD You can also complain to the ICO if you are unhappy with how we have used your data by writing to: Information Commissioner’s Office Wycliffe House Water Lane Wilmslow Cheshire SK9 5AF Helpline number: 0303 123 1113 ICO website: https://www.ico.org.uk Changes to this privacy notice We may change this privacy notice and we encourage you to check this privacy notice from time to time Learner Records Service Privacy Notice The information you supply is used by the Learning Records Service (LRS). The LRS issues Unique Learner Numbers (ULN) and creates Personal Learning records across England, Wales and Northern Ireland, and is operated by the Education and Skills Funding Agency, an executive agency of the Department for Education (DfE). For more information about how your information is processed, and to access your Personal Learning Record, please refer to: https://www.gov.uk/government/publications/lrs-privacy-notices Featuring my work and materials I agree to my College experience and progress featuring in College publicity or guidance materials in written, photographic or video format. DeclarationI understand that if I do not provide evidence of eligibility for fee remission within one month of my enrolment I will be liable for the full fees regardless of if they are provided at a later date. Refunds, including exam fees will only be given in exceptional circumstances. I confirm that the information on this form is accurate and I will inform the College if any details change regarding my name, address, employment status etc. I understand the college will keep parents / carers / employers informed of my progress. By clicking continue on this page, you electronically agree that all of the information submitted in this form is accurate to the best of your knowledge and that you agree with the above declaration points, which you must check to prove you have read, understand and agree with them. Important Before you submit this form, you will need to have all of the following available A photo to upload for your student ID (if you have previously said you have one available, if not don't worry we can take one at college). Funds will need to be available to pay your first instalment of £[first-instalment] as soon as you submit this form. Have access to your [email] email account to accept the email invite to e-sign your enrolment form. If you don’t have all the above available now, please click the save and continue button above and once you have all the information and funds, you can come back and complete your enrolment. We will keep all your enrolment information available for you for 30 days from today. If you do have all of the information and funds available, please click the next step button to finalise your enrolment today. If you have any questions or need any assistance e-signing your enrolment, please contact the college on 01484 437 000. Uploads Photo for your student ID and pass (please see acceptable examples below) Note: If you do not wish to upload a photo or your photo does not meet our criteria. We will take your photo in college, and then issue your student identification badge. Please ensure the photo you upload meets the requirements as illustrated in the example images below: Upload Your Student ID PhotoIf you do not upload a photo for your Student ID as part of this enrolment, your photo will be taken on your first day at college, so that your ID card can be produced. Accepted file types: png, jpeg, jpg, Max. file size: 5 MB. Thank you for choosing to enrol on the [courseTitle] Here’s a quick reminder of what happens as soon as you submit your enrolment below: Remember: You can save the progress of your form and return at any point, simply click the Save & Continue Later link shown below. You will be emailed a copy of your completed enrolment form which includes the declarations you have made, which you will need to electronically sign. This is a quick and simple process, just follow the instructions in the email. This may take up to 20 minutes to reach you. If you do not receive your form to sign within this time, please contact the college on 01484 437 000 to get a copy resent. If you are all ready to proceed, click SUBMIT ENROLMENT below
