2019/2020 - Student Enrolment Form & Learning Agreement Please help us by completing this form as fully as possible in BLOCK CAPITALS using a black or blue ballpoint pen.

Please ensure that you read the learning agreement and student privacy statement before signing Part B.

1. Personal Details (*Please provide your Legally Registered details)

Title (e.g. Ms/Mrs/Miss/Mr)

First Name

Surname (Family Name)

Course Applied To

Middle Name

Date of Birth

Current Address

Age on 31/08/2019

Sex*

Postcode

Accommodation Are you living away from home and in College Accommodation? Yes No

National Insurance No

Personal Email Address

Last School Attended (under 19 only)

Have you ever studied at Brooksby Melton College before? Yes No If Yes, which year did you start your studies?

Name

Relation to you

Contact Email

No

46 Any Other Black/African/Caribbean Background

Name

Relation to you

Contact Email

Part A

Male Female

4. Ethnicity How would you best describe yourself

31 English/Welsh/Scottish/Northern Irish/British

32 Irish

35 White and Black Caribbean

33 Gypsy or Irish Traveller

36 White and Black African

34 Any Other White Background

37 White and Asian

38 Any Other Mixed / multiple ethnic background

41 Bangladeshi

39 Indian

42 Chinese

40 Pakistani

43 Any Other Asian Background

44 African

47 Arab

45 Caribbean

98 Any Other Ethnic Group

Office Use Only Student ID No Unique Learner Number

Identification verified and checked: Type Date Initials

/ M M / D D

Y Y

/ M M / Y Y Y Y D D

Office Use Only Student ID No Unique Learner Number

Identification verified and checked: Type Date Initials

/ M M / D D

Y Y

Duration at Current Address Years Months

Telephone Home Mobile

Contact Number Contact Number

2. Emergency Contact Details (if you are under 18, please provide parent/carer details) - please tell them you are providing us with this optional information

Office Use Only

3. Residency Please complete the relevant sections

Have you been living in the UK or EEA for the last 3 years? Yes

In which country do you normally live?

Are there any restrictions on the length of your stay in the UK?

Are you a Refugee, Asylum Seeker or fall under another immigration status? No

Yes No

No

Date of entry into UK / M M / D D Y Y Y Y

Office Use Only Notes:

Yes

Probationary Enrolment Office Use Only

Member of Staff

46 Any Other Black/African/Caribbean Background

(If you answered Yes please go to section 4)

5. Learning Difficulties, Disabilities and Health Problems

In order that Brooksby Melton College can provide appropriate support for you, please tell us about any particular learning difficulty, disability or health problem you may have

Any information you provide will be shared with the appropriate people in the College who can offer you suitable support throughout your studies

Do you consider yourself to have a learning difficulty, disability or health problem? Yes No

Do you consider that you may need additional support whilst attending the College? Yes No

I have had special arrangements for exams before

I have had learning support before

Please tick all that apply

04 Visual impairment

06 Disability affecting mobility

96 Other learning difficulty

10 Moderate learning difficulty

12 Dyslexia

14 Autism spectrum disorder

16 Temporary disability after illness (e.g. post-viral) or accident

93 Other physical disability

95 Other medical condition (e.g. epilepsy, asthma, diabetes)

08 Social and emotional difficulties

05 Hearing impairment

07 Profound complex disabilities

11 Severe learning difficulty

13 Dyscalculia

15 Asperger’s syndrome

17 Speech, Language and Communication Needs

94 Other specific learning difficulty (e.g. Dyspraxia)

97 Other disability

09 Mental health difficulty

Please indicate the number of your main Disability or Health Problem

6. Qualifications already held

Please indicate the highest level of qualification when you first enrolled at this College. If there has been a break in learning please indicate current level.

09 Entry level (Essential Skills, entry level literacy or numeracy)

07 Other qualification below level 1

02 Full level 2 (5 GCSEs grade A*-C or 9-4, NVQ2, IBT2, ECDL)

03 Full level 3 (NVQ3, AVCEs, 4 AS levels, 2 A levels)

01 Full level 1 (NVQ1, CLAIT, Foundation level)

10 Level 4 (HNC/D, AAT4, NVQ4)

11 Level 5 (Foundation/First Degree (non-hons), HND)

13 Level 7 and above (Masters/Doctorate Degree, PGCE)

99 No qualifications

12 Level 6 (First Degree (hons))

Yes

Yes

Maths English Language

English Literature

GCSE Maths equivalence

Office Use Only Record the student’s GCSE grades for Maths and English

Grade achieved

Grade achieved

Grade achieved

Grade achieved

Year taken

Year taken

Year taken

Year taken

GCSE English equivalence

Grade achieved Year taken

English Spoken Language

Unit (P/M/D) Grade achieved Year taken

7. Household Situation 19+ only

Individuals from all walks of life have benefited from programmes supported by the European Social Fund (ESF), to help with this please indicate your household situation below:

01 No household member is in employment and the household includes one or more dependent children

02 No household member is in employment and the household does not include any dependent children

03 Student lives in a single adult household with dependent children

98 Prefer not to say

99 Not applicable

Board

9. Privacy Notice

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 per-

sonal information will be used by the DfE, the ESFA (an executive agency of the DfE) and any successor bodies to these organisations. 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 will be securely destroyed after it is no longer required for these purposes.

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 Au-

thority (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.

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.

You can agree to be contacted by other third parties by ticking any of the following boxes:

Tick this box if you agree to be contacted in respect of surveys and research.

Tick this box if you agree to be contacted about courses or other learning opportunities.

Your agreed contact method - tick all that apply Post Telephone

Email

Personal Learning Record (PLR)

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 North-

ern 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 pro-

cessed, and to access your Personal Learning Record, please refer to: https://www gov uk/government/publications/lrs-privacy-notices

Office Use Only

Score

Initial assessment completed

Referred to Learning Support (ALS)

Student Privacy Statement A copy of the full notice is available to view at enrolment or can be accessed at any time on the College Website: https://www brooksbymelton ac uk/policies-and-procedures/

Were you in full-time education or training prior to enrolment? Yes No

8. Employment Status What will your employment status be prior to your enrolment?

In paid employment - if so, please indicate hours below

Self employed

Employed Not Employed

0-10 hours per week

11-20 hours per week

21-30 hours or more per week

Not in paid employment, looking for work and available to start work

Not in paid employment, not looking for work and/or not available to start work

How long have you been employed? How long have you been unemployed?

Up to 3 months 4—6 months

7—12 months More than 12 months

Less than 6 months 6 - 11 months

24—35 months 36 months or more

12—23 months

31+ hours or more per week

Further 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

10. Learning Agreement 2019/2020

Declaration of Student

Initial Advice and Guidance

I confirm that as part of my initial guidance, enrolment, induction and tutorial activities:

∙ I identified any additional support I may require due to a learning difficulty or disability or as part of my EHCP

∙ I identified my primary learning goals and programme of study

∙ I met the appropriate entry requirements for this programme of study

∙ I understood what the programme of study involved, including any fees liability and costs of study

∙ I was made aware of the learning, financial, transport, careers, health and other welfare support to which I may be entitled

Rules, Regulations and Codes of Conduct

∙ I agree to conform to the rules, regulations and codes of conduct of the College. (For further information see Student Handbook)

∙ I agree to abide by the health and safety rules and regulations and instructions issued by college staff

∙ I have disclosed anything that will affect my suitability for a programme of study, work placement, my personal safety or the safety of others

∙ I have declared that, to the best of my knowledge, the information I have provided is correct. Should my circumstances change I will notify the College immediately

What you can Expect

Stay Safe

∙ A learning environment which meets health and safety standards, including staff trained in safeguarding and the PREVENT agenda focused on young people and vulnerable

adults

∙ A robust approach to on-site security with a requirement for staff, students and visitors to wear an ID badge/visitors pass. College staff will conduct identity spot checks .

∙ Appropriate risk assessments for visits and work placements

Be Healthy

∙ Access to confidential counselling, with relevant referral to outside specialist support agencies

∙ Healthy options in catering outlets

∙ Access to fitness activities

∙ College events promoting health and wellbeing

Enjoy and Achieve

∙ Up to date course information and guidance on selecting the right course

∙ A Personal Tutor who will help to plan, monitor and review your learning and progress at regular intervals

∙ High quality teaching and learning with well prepared materials

∙ Appropriate support if you have particular learning needs e.g. study skills, handwriting, reading speed, dyslexia etc

Economic Wellbeing

∙ Advice on finance, transport, childcare and general welfare issues

∙ Access to careers advice and promotion of employability skills

Positive Contribution

∙ An opportunity to provide feedback on the quality of services provided by the college

∙ An opportunity to be an active member of the Student Council and to vote in student elections

∙ An opportunity to act as a course representative to support fellow students

∙ Opportunities to volunteer in other ways to support your personal development

What we Expect – Attendance, Behaviour and Commitment

Attendance

∙ An adult approach to attendance and punctuality, as if you were in employment. You should have 100% attendance and punctuality for all elements of your programme of

study, including English and Maths with no unauthorised absences and arrive at lessons on time

∙ Inform the college in advance of any absences by correct use of the notified absence system

∙ Attend all 1:1 appointments with your tutor or other college staff

Behaviour

∙ To apply British values and be considerate to the rights and interests of other College users and our neighbours

∙ Take care of the college environment, buildings and furnishings and respect other people’s property, including computer-based information

∙ To fully embrace the College’s RESPECT campaign and to ensure that you are considerate to the following nine protected characteristics: age, disability, gender reassignment,

marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex and sexual orientation

∙ Co-operate with staff and fellow students

Commitment

∙ Accept that the responsibility for your learning rests with you, by being active in the planning of your programme and the reviewing of your progress with your tutors

∙ Complete assignments, meet deadlines and work to the best of your ability, discussing with your tutors circumstances which may prevent this

∙ Make proper use of the study facilities

∙ Contribute positively to the College community, e.g. by supporting the Student Council, participating in Theme Weeks or other College events

If you are under 18 years of age at the time of enrolment, the College will normally share information about all aspects of your progress, including unreported absence, with

your parents or guardians. If you are employed and your employer is contributing to your fees or is giving you time off work to attend, we will normally share information

about your progress and attendance with your employer.

In addition we expect you to abide by all College policies that apply to students. You can find all these policies on the Student Services section of Moodle.

Office Use Only

Evidence provided and copies taken of examination results

College ID completed by IT Support

Advice on fees and payments made (Finance)

Enrolment Form completed, checked and signed by MIS

Transport information provided (where applicable)

Checked by

Entered onto EBS

Registered

Notes

Date

Date

ILR

Learning Support

Exams