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Personal Details

Emergency Contact Details

Parental Responsibility (if under 18)

Education & Training

Employment Details

Course

Privacy Notice

Declaration

Apprenticeship Enrolment Form

The information collected on this form is to establish your eligibility for funding against an apprenticeship and the suitability of the apprenticeship in line with your job role and will be used to provide the delivery of the apprenticeship PLEASE COMPLETE ALL FIELDS MARKED * AND ENSURE THAT YOU READ ALL STATEMENTS

Title

First name(s)*

Last Name*

Sex*

The UK government defines gender/sex as:

• referring to the biological aspects of an individual as determined by their anatomy, which is produced by their chromosomes, hormones and their interactions

• generally male or female

• something that is assigned at birth

The funding guidelines from the Department for Education require this question to be answered to proceed with your enrolment.

NI Number (No spaces)

Date of birth*

Address line 1*

Address line 2

Address line 3

Town*

County

Postcode*

E-mail*

Mobile

Phone

Emergency Contact Name*

Contact Relationship

Contact email

Contact Phone Number

You only need to supply these details if you are under 18 years old at the start of the apprenticeship

Next of Kin Name

Next of Kin Phone Number

Next of Kin relationship

Please enter below any qualifications you already hold, do not include English/Maths GCSE if filled out above. Please also inlcude any training relevant to the qualificaiton applied for even if you did not get a certificate.

Employment Status

Employer Name

Start Date with Employer

Job Title/Role

Start Date in Role

Employment Contract

Hours per week in role

Part TIme Role?

Apprenticeship as part of

Working Pattern Details (i.e. Mon-Fri 9am - 5pm)

Employer Contact Name

Employer Contact Phone

Employer Contact Email

Employer Address 1

Employer Address 2

Employer Town

Employer Postcode

Course Applying For

Reason for choosing this course

How did you find out about this course?

What do you hope to learn from this course?

Privacy Notice - Click here to view

I declare i have read the above privacy notice

Contact Methods allowed

Email
No Contact
Phone
Post

Awarded Date

I confirm that I have checked the information on this form and it is correct. I agree to abide by the Provider’s Enrolment and Learning Agreement as detailed in the Confirmation Sheet. I am eligible to take part on this Apprenticeship Standard and I have declared my eligibility correctly. The level of Apprenticeship I have chosen suits my qualifications and/or prior experience. I am entitled to educational help I need to complete the course and know how to access it. I must be diligent, punctual and attend courses and agreed sessions. If I fail to attend 3 consecutive sessions or if my attendance is erratic, I will be withdrawn from my programme. I consent to the data contained in this form being stored in a computerised database, shared with , Department for Education, Skills Funding Agency, ESF and Exam Boards as appropriate. All data will be stored in accordance with the provisions of the Privacy Statement above. I am agreeing to the leadership team in processing information regarding my prior attainment levels and to share that information with the Department for Education and other Government bodies. I confirm that I have been informed about and have knowledge in the Safeguarding Policy, Appeals Policy and Learning Agreement. I confirm that I have been informed about and have knowledge in the Equality & Diversity Policy, Health & Safety Policy and have access to the documents from my employer.

Learner Signature

Apprentice Signing:

Apprentice Signed Date