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Learning Agreement – QN1917F ESOL Conversation Class E2/E3
"
*
" indicates required fields
1
Course Details
2
Contact Details
3
Personal Details
4
Residency & Identification
5
Employment Status
6
Prior Learning
7
Privacy Statement
8
Contact Preferences
9
Learner Declaration
Course Code:
*
Hidden
Course Tutor
*
Course Title:
*
Hidden
Primary Learning Aim
Hidden
Learning Aim Title:
Hidden
Start Date
Hidden
Planned End Date
Hidden
GLH
Name
*
Mr
Mrs
Ms
Miss
Mx
Title
Given Name
Family Name
Sex
*
Male
Female
Date of Birth
*
DD slash MM slash YYYY
Address
*
Street Address
Address Line 2
Town
Post Code
Telephone Number
*
Email Address
Emergency Contact Name:
Emergency Contact Number
Ethnic Origin
*
please select
English/Welsh/Scottish/Northern Irish/British
Irish
Gypsy
Irish Traveller
Any Other White Background
White and Black Caribbean
White and Black African
White and Asian
Any other Mixed/Multiple Ethnic Background
Indian
Pakistani
Bangladeshi
Chinese
Any other Asian Background
African
Caribbean
Any other Black/African/Caribbean
Arab
Any other Ethnic Group
Learning Support
If you consider yourself to have a disability or learning difficulty please tick any that apply.
Vision impairment
Hearing impairment
Speech, Language and Communication Needs
Disability affecting mobility
Profound complex disabilities
Social and emotional difficulties
Mental health difficulty
Moderate learning difficulty
Severe learning difficulty
Dyslexia
Dyscalculia
Autism Spectrum disorder
Asperger’s Syndrome
Temporary disability after illness or accident
Other physical disability
Other specific learning difficulty
Other learning difficulty
Other medical condition
Other disability
Support contact
If you have indicated a medical condition, disability and/or learning difficulty, would you like us to contact you to discuss your additional support requirements?
Yes
No
Are you a UK national?
*
Yes
No
Have you been a permanent resident in the UK for at least the last 3 years?
*
Yes
No
If you have not previously completed our learner residency declaration since 1st July 2021 you will need to do so. This declaration can be found at,
https://www.skillsandlearningace.com/learner-residency
. You will need to provide evidence of your residency and if you are the dependent of someone else then evidence of theirs.
Evidence of identification
To verify your identification please upload a scanned image or photograph of one of the following forms of ID, including but not limited to: passport, driving licence, ID card or other national identification.
Accepted file types: jpg, jpeg, png, pdf, Max. file size: 10 MB.
What is your employment status?
*
please select
In paid employment
Unemployed looking for work
Unemployed not looking for work
Retired
How many hours are you employer for?
*
If you are on a zero hour contract please select the average hours you’ve worked over the past month.
please select
0 to 10 hours per week
11 to 20 hours per week
21 to 30 hours per week
31 hours or more per week
Please tick if you are self employed
*
Yes
No
How long have you been unemployed for?
*
please select
less than 6 months
6-11 months
12-23 months
24-35 months
36+ months
Please select which (if any) benefits you are in receipt of
*
please select
Job Seekers Allowance (JSA)
Employment Support Allowance (ESA)
Universal Credit
Other state benefits
Not claiming benefits
National Insurance Number
*
This should be in the format of QQ123456C
Household Situation
*
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 in the household
None of these statements apply
I confirm that I wish to withhold this information
Priority Group
Recurring Unemployment
Recently made redundant
At risk of redundancy
On furlough
Lone parent
Looking after dependents
Homeless
Living in temporary accommodation
Prior Attainment
*
Please indicate the highest level of qualification you have achieved in any subject.
please select
Entry Level (Basic skills qualifications)
Level 1 (NVQ 1, GCSEs 5 at D-G/3-1 or less than 5 at A-C/9-4)
Level 2 (NVQ 2, GCSEs 5 at A*-C/9-4 or 3 AS Levels)
Level 3 (NVQ 3, 2+ A Levels or 4+ AS Levels
Level 4 (NVQ 4, Certificate of Higher Education)
Level 5 (Foundation Degree)
Level 6 (Honours Degrees)
Level 7 and above (Master's Degree/Doctorate)
No qualifications
Are you undertaking any other government funded training?
*
Yes
No
Details of training
*
Access to ICT & Digital Skills
Please consider your current ICT skills and rate how confident you feel.
Internet
Very confident
Fairly confident
Neither
Not very confident
Not at all confident
Email
Very confident
Fairly confident
Neither
Not very confident
Not at all confident
Word Processing
Very confident
Fairly confident
Neither
Not very confident
Not at all confident
Do you have regular access to a PC, laptop or table to help with your learning?
Yes
No
Do you have a reliable internet connection?
Yes
No
How we (S&L) use your Personal Information
There are legal reasons why we need to collect and use your personal information. These reasons are:
Contract: you have entered into a contract with us
Legal obligation: it is required by law under the Apprenticeships, Skills, Children & Learning Act 2009
We will collect enough personal information in order to provide you with government funded training and education. The information we collect from you will be less if your training and education is not partly or fully government funded and will not be shared with any other organisation. This information will be shared with the Education & Skills Funding Agency if your course is fully or partly funded. Details of how they use your personal information is below. We will also share your personal information with:
The Awarding Body of any exam you undertake
An approved third party contractor who will contact you in order to collect information on the impact and outcomes arising from your learning with us
Taxi companies or childcare providers where we organise these for you
If applicable, the Student Loans Company in connection with grants, fees, loans & bursaries
If applicable, other third party agencies who referred you to Skills & Learning, in order that we can provide them with confirmation of your attendance and progress on your course. These could include:
JobCentre Plus
Government Funded Training Providers
National Careers Service
The NHS (Track and Trace), if needed, in order to help contain clusters and outbreaks during the coronavirus pandemic
The personal data that is shared will always be limited to what the other organisation needs to meet its requirements or deliver its services. Your information will be securely destroyed after it is no longer required for these purposes. We are not permitted to collect information we do not need or will not use. We will never sell your personal information. Full details of how we use your personal information are available on our website
https://www.skillsandlearningace.com/policies
.
How the Education & Skills Funding Agency 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) 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.
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. We retain ILR learner data for 3 years for operational purposes and 66 years for research purposes. For more information about the ILR and the data collected, please see the ILR specification at
https://www.gov.uk/government/collections/individualised-learner-record-ilr
ILR data is shared with third parties where it complies with DfE data sharing procedures and where the law allows it. The DfE and the English European Social Fund (ESF) Managing Authority (or agents acting on their behalf) may contact learners to carry out research and evaluation to inform the effectiveness of training.
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 ESFA Privacy Notice (
https://www.gov.uk/government/publications/esfa-privacy-notice
)
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, Ministerial and Public Communications Division, Department for Education, Piccadilly Gate, Store Street, Manchester, M1 2WD
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
Data Protection and Privacy Notice Confirmation
*
I have read and understood this data protection and privacy notice.
Contact Preferences
We (or the Education & Skills Funding Agency) would like to send you information about our courses, learning opportunities and for surveys and research by post, telephone or email. If you agree to being contacted in this way please tick the relevant box(es) below:
Reason for contact
About courses or learning opportunities
For surveys and research
How contact is allowed
Preferred method of contact?
By post
By phone
By e-mail
We will use the contact details held to contact you with information relating to your course(s).
How did you hear about us?
Another organisations website
Brochure (door to door delivery)
Contacted by provider
Event
Referral
Skills & Learning Website
Targeted e-mail
Word of Mouth
Social Media
Learner Declaration
I confirm that
The personal information I have provided is correct and that I am not studying this course with another provider.
I understand that if I have declared false information Skills & Learning may take action against me to reclaim fees and any support costs provided.
I am aware my details will be sent to the Learner Registration Service and used to create and maintain a Unique Learner Number and Personal Learning Record.
I have read and understood the Skills & Learning Terms and Conditions
https://www.skillsandlearningace.com/terms-and-conditions
(opens in a popup window).
I have received sufficient information and guidance about the course I am going to do and believe it is at the right level for me.
I agree that
I will inform Skills & Learning of any unspent criminal convictions (please refer to Learner Handbook for guidance).
I will complete the course detailed above and undertake the work required.
I will sit the exam/assessment required to achieve the qualification (if applicable) and submit all required coursework.
I will undertake independent study and homework to help me progress quickly.
I will attend regularly and arrive on time.
I will inform Skills & Learning if I am unable to attend.
Attendance will be monitored and if I miss 3 sessions in a row, or 2 in a term, I will be contacted for a discussion which may result in being withdrawn from the course.
I will help support the future funding of adult learning by providing feedback on the impact of having undertaking this learning programme.
Signature
*
Please draw your signature either with your mouse or if you have a touchscreen with your finger or stylus.
Date
*
DD slash MM slash YYYY
Signing above confirms that the declarations you have made in this form are a true and accurate reflection of your circumstances.
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