Learner Enrolment Form

Please note: Unless otherwise stated, all fields are required.

To be eligible for funding you must tick to confirm you meet the following criteria:

I currently live in England or Scotland

I have lived in the United Kingdom for the last 3 years

I was aged 19 or over on 31st August 2024

I have not studied the course I am applying for before

I am not currently enrolled on any other government funded education programme, either with Burnley College or any other provider

Personal Details

Where do you live?

Chosen Course

Title

Given Name

Middle Name(s) (optional)

Family Name

Previous Surname (optional)

Biological Sex

Male

Female

Is your gender different from the sex you were assigned to at birth?

Yes

Prefer not to say

Marriage/Civil partnership status

Date of Birth

National Insurance Number

0/9

First line of address

City / Town

County / Region

Postcode

Years at current address

Note: If you have lived at your current address for fewer than 3 years, previous address details will be required.

First line of previous address

Second line of previous address

Previous Postcode

Contact telephone number

Mobile number

Email address

The Email fields do not match.

Confirm email address Error: The Email fields do not match.

The Email fields do not match.

Previous College/School (optional)

Diversity Information

Nationality

Date of Entry into the UK

Were you born outside of the UK/EU/EEA?

Yes

Have you been a resident in the UK , EU, EEA for the last three years?

Yes

Previous Country of Residence

First language

Ethnicity

Religion / Faith

Are you in or have you recently left care?

Yes

Sexual orientation

Do you have any unspent criminal convictions or cautions, except for minor motoring offences, in accordance with the Rehabilitation Act 1974?

Yes

Disability

Learning Difficulty

Do you have an education and health care plan (EHCP)?

Yes

Do you require any additional support with your studies?

Yes

Qualifications and Employment Details

GCSE English Language Grade

GCSE Maths Grade

If you are in Scotland please input your National or Standard grades.

Highest Qualification Achieved

What is the title/name of your highest qualification (optional)

Are you currently in full-time education?

Yes

Employment Status

Date Unemployment Started

Length of Unemployment

Household Situation

Emergency Contact Information

Please note: Providing an emergency contact is an essential requirement for obtaining funding. This will not be shared or used in any way other than in an emergency. For distance learning learners this is highly unlikely but remains a requirement of the funding body.

Emergency Contact Name

Emergency Contact Relationship to Me

Emergency Contact Phone

Emergency Mobile Number

Emergency Contact Address Line One

Emergency Contact Town

Emergency Contact County (optional)

Emergency Contact Postcode

Final Details

Why do you want to study this course?

To develop my knowledge about this subject area

To gain a qualification

I have spare time and want something to do

None of the above

My reason for choosing this distance learning course is:

Seeing a tutor or fellow students face to face is:

I would classify myself as someone who:

Classroom discussion is:

When a tutor hands out directions for an assignment, I prefer:

I need feedback on my assignments:

Considering my professional and personal schedule, the amount of time I have to work on a distance learning course is:

When I am asked to learn technologies that are new to me:

As a reader, I would classify myself as:

If I am asked to use computers I:

Preferred Contact Method (optional) This is how we will contact you about your application.

Text

Phone call

Preferred Marketing Methods (optional) Please select how you would like to receive marketing communications.

Text

Phone

Upload a copy of your passport / driving licence / birth certificate

Must be a .jpeg, .jpg, .png, .pdf, .doc or .docx and must be less than 10MB in size

Providing proof of your identity is a mandatory requirement in order to access funding. If this is not provided you will be deemed ineligible for funding and not permitted to access your chosen course. Examples of acceptable evidence are: Passport, Birth Certificate, Driving Licence

ID Document Reference Number

For example: Passport number, driver number

Form of ID given

GDPR 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.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 via: Online contact form https://www.gov.uk/government/organisations/department-for-education/about/personal-information-charter Telephoningthe DfE Helpline on 0370 000 2288 Writing to – Data Protection Officer, Ministerial and Public Communications Division, Department for Education, Piccadilly Gate, Store Street, Manchester, M1 2WDIf 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 The course(s) you are enrolling on may be co-financed by the European Social Fund and this may require your data to be shared accordingly. This will be in accordance with the 1998 Data Protection Act.

Student Declaration

I confirm that all the details on this enrolment are correct and apply to course(s) on this enrolment only. If I have declared any false or irrelevant information that may affect my enrolment, action may be taken against me to reclaim course fees and any support costs provided. I understand that if any information included within this enrolment form changes prior to the start date of my course I will inform Student Services immediately as this may affect my enrolment and my course fees. I can confirm that I agree that If I do not fully complete this course, I will be liable for a £150 fee upon withdrawal.

Acceptable Use of Comptuters

Burnley College provides Internet access and other computer services to students for communication and study purposes, to support education and to enhance the learning process. Under the Regulation of Investigatory Powers Act, the College has the right, in certain circumstances to monitor any of its computer systems that are made available to you in College, to monitor, intercept and/or record communications made including e-mail or Internet communications. You should, therefore, have no expectation of privacy in any electronic communication sent or received. Acceptable use requirements apply to devices provided by College, and also any personal devices you bring onto College premises.

You must not

Waste staff effort or networked resources

Use computers in a way that denies service to other users

Unlawfully copy software owned and licensed by the College

Corrupt or destroy other users, or College data

Pass on personal details without that person’s consent

Access, send or store emails, or any material that is inappropriate, inc. extremist or sexual content

Attempt to access, or access restricted areas on the computer or servers, includes logging on using somebody else’s password without express permission

Freedom of Information Act

Burnley College is committed to openness and transparency in the way it conducts its business. To comply with the Freedom of Information Act the College has adopted the ‘model’ publication scheme for Higher Education / Further Education establishments. This publication scheme outlines the classes of information we are prepared to release, although much information is free it also details where any charges will apply. The publication scheme in full can be accessed through the College website Freedom-of-Information-Policy.pdf (burnley.ac.uk).

Signature

Please provide your full name below:

Full name