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Personal Details


Title
First Name

This should be your legal name. This will then be used for all our communications, official documents (e.g. certificates), and correspondence.

Surname

Date of Birth


Gender at Birth

Please enter as stated on your birth certificate or other legal documents

Mobile
Home telephone number
Email Address
Email Address (enter again)
     

Please supply your personal email address. This is the address we'll use to confirm your enrolment and to send any digital certificates to

National Insurance No.
Ethnic Group
Will you have lived continuously in the UK for more than 3 years on the first day of your course?
Is Home Fees

Please contact our enquiries team on 01332 956565 so they can check your eligiblity for this course



Address

Property/Street
Address Line 2
Town / City
County

Postcode



Education

What is your highest level of Qualification?

Use the following to help you pick the correct qualification level...

Help me pick the right level

Entry Level

Entry level qualifications are:

  • entry level award
  • entry level certificate (ELC)
  • entry level diploma
  • entry level English for speakers of other languages (ESOL)
  • entry level essential skills
  • entry level functional skills
  • Skills for Life

Level 1

Level 1 qualifications are:

  • first certificate
  • GCSE - grades 3, 2, 1 or grades D, E, F, G
  • level 1 award
  • level 1 certificate
  • level 1 diploma
  • level 1 ESOL
  • level 1 essential skills
  • level 1 functional skills
  • level 1 national vocational qualification (NVQ)
  • music grades 1, 2 and 3

Level 2

Level 2 qualifications are:

  • CSE - grade 1
  • GCSE - grades 9, 8, 7, 6, 5, 4 or grades A*, A, B, C
  • intermediate apprenticeship
  • level 2 award
  • level 2 certificate
  • level 2 diploma
  • level 2 ESOL
  • level 2 essential skills
  • level 2 functional skills
  • level 2 national certificate
  • level 2 national diploma
  • level 2 NVQ
  • music grades 4 and 5
  • O level - grade A, B or C

Full Level 2

Full Level 2 qualifications are:

  • GCSE/O Level (5 or more GCSEs grades A*-C)
  • GCSE (9-1) (5 or more GCSEs grade 4 or above)
  • 2 or 3 AS Levels (for AS qualifications regulated before 1 September 2015)
  • CSE Grade 1 (5 or more)
  • 1 A Level
  • Higher 14-19 Diploma
  • QCF Diploma level 2
  • QCF Certificate level 2 at 13 or 14 credits undertaken before
  • 2014 to 2015
  • Level 2 Principal Learning
  • NVQ level 2
  • GNVQ Intermediate
  • Technical Certificates in the 16-19 Performance Tables
  • QCF Certificate level 2 at 15 credits and above

Level 3

Level 3 qualifications are:

  • A level
  • access to higher education diploma
  • advanced apprenticeship
  • applied general
  • AS level
  • international Baccalaureate diploma
  • level 3 award
  • level 3 certificate
  • level 3 diploma
  • level 3 ESOL
  • level 3 national certificate
  • level 3 national diploma
  • level 3 NVQ
  • music grades 6, 7 and 8
  • tech level

Full Level 3

Full Level 3 qualifications are:

  • A Levels (2 or more advanced level passes)
  • 4 or more AS Levels (for AS qualifications regulated before 1 September 2015)
  • QCF Diploma Level 3
  • QAA Access to HE
  • Advanced 14-19 Diploma
  • GNVQ Advanced
  • NVQ level 3
  • AVCE double award
  • Tech Levels which are in the 16-19 Performance Tables
  • Applied Generals which are in the 16-19 Performance Tables
  • (from 1 August 2015)
  • QCF Certificate at Level 3 which is 30 to 36 credits

Level 4

Level 4 qualifications are:

  • certificate of higher education (CertHE)
  • higher apprenticeship
  • higher national certificate (HNC)
  • level 4 award
  • level 4 certificate
  • level 4 diploma
  • level 4 NVQ

Level 5

Level 5 qualifications are:

  • diploma of higher education (DipHE)
  • foundation degree
  • higher national diploma (HND)
  • level 5 award
  • level 5 certificate
  • level 5 diploma
  • level 5 NVQ

Level 6

Level 6 qualifications are:

  • degree apprenticeship
  • degree with honours - for example bachelor of the arts (BA) hons, bachelor of science (BSc) hons
  • graduate certificate
  • graduate diploma
  • level 6 award
  • level 6 certificate
  • level 6 diploma
  • level 6 NVQ
  • ordinary degree without honours

Level 7

Level 7 qualifications are:

  • integrated master’s degree, for example master of engineering (MEng)
  • level 7 award
  • level 7 certificate
  • level 7 diploma
  • level 7 NVQ
  • master’s degree, for example master of arts (MA), master of science (MSc)
  • postgraduate certificate
  • postgraduate certificate in education (PGCE)
  • postgraduate diploma

Level 8

Level 8 qualifications are:

  • doctorate, for example doctor of philosophy (PhD or DPhil)
  • level 8 award
  • level 8 certificate
  • level 8 diploma



We need your expected or achieved qualifications to make sure you are applying for the right course. Please include information on all qualifications studied i.e. GCSE, BTEC diplomas, A-levels, NVQs. If you haven’t yet taken your exams, please provide your predicted grades.

Entering Maths & English Qualifications is mandatory


If you have no qualifications, then please press ‘No prior qualifications’. Use ‘Add row’ to save and add multiple qualifications.

To remove items, please press ‘No prior qualifications’ then press ‘Add Qualifications’




Subject
Grade
Date
Level



Learner Support

We collect information relating to special educational needs, disabilities and additional support so our learning support team can work with you to ensure that you receive the appropriate help and advice to achieve your full potential

Do you have a learning difficulty, disability, health problem, or any illness that could affect your learning
Primary Disability/Learning Difficulty
Secondary Disability/Learning Difficulty

Please enter any more information you would like us to know

Notes


Student Detail User Defined7

Household & Employment

Describe best your household situation



Employment Status

How many hours per week?
For how long have you been employed?

Are you self employed?

Is Self Employed
Length of Unemployment (If Unemployed)

Choose your type of benefits, if none apply please leave blank

Benefit Status

Evidence

You may upload 1 form of Identification

You may also upload your proof of Qualifications (Results slip / certificates)

Accepted forms of Identification:

  1. Current signed passport
  2. Original birth certificate (UK birth certificate issued within 12 months of the date of birth in full form including those issued by UK authorities overseas such as Embassies High Commissions and HM Forces)
  3. Current UK photocard driving licence
  4. Full old-style driving licence
  5. Residence permit issued by the Home Office to EEA nationals on sight of own country passport
  6. National identity card bearing a photograph of the applicant

You may also upload specific evidence for your Funding Declaration / Course Requirements - please see the table below for what you should upload:

To evidence your eligibility:
Option Evidence to Upload
I am on Benefits Please provide a Universal Credit Statement, screenshot or proof of benefits
Universal credit Please provide a Universal Credit Statement
Low income 3 months of wage slips
Type of Evidence
Notes
Upload File

Contact Preferences

We will normally contact you by email and/or text message with important updates about your course(s), centre closures and our important termly updates.



How would you like us to contact you? (please select at least one)

Email
Phone
Post


From time to time - we would like to contact you about other learning opportunities and research - please select which you would like to hear about

Learning Opportunities
Research




How did you hear about us?

Privacy Notice

Derby Adult Learning Service is part of Derby City Council, the local government unitary authority for Derby City. We provide education and training for adults aged 19+ funded by the Education and Skills Funding Agency (ESFA). Data Controller: Derby City Council, Our address is:  The Council House, Corporation Street, Derby, DE1 2FS

The personal information we collect from you is used to:

  • Fulfil our contractual obligations with the ESFA and other government departments from whom we receive funding
  • Assess your eligibility for government funding
  • Process financial transactions i.e., payments course fees, exam costs and materials
  • Update the Student Loans Company with required attendance and financial information
  • For teaching, learning and assessment purposes including use of our electronic portfolios/e-learning platform
  • Notify you of changes to our services including class closures/cancellations
  • Ensure your health, safety and well-being

Please familiarise yourself with the following privacy notices which will provide you with further information about use of and access to your personal data, and details of organisations with whom we regularly share data: Derby Adult Learning privacy notice

Education Skills Funding Agency privacy notice

Learner Records Service privacy notice If you have any questions about this policy or the ways in which we use your personal information, please contact our Data Protection Officer on 01332 640763 or email data.protection@derby.gov.uk

Please confirm:


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