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Please write here any comments you would like to make about ADULT &
the course COMMUNITY

Course Details
Provider Course
Would you recommend this course to a friend? YES NO
SECTION 6 Learner
For family learning courses only
How has this course helped you to How has attending the course benefited (optional)
support your child's learning? your child?
Start date End date

Programme Area (Please tick)

Ethnicity - Please indicate your ethnic background
Black/African/Caribbean/Black British ESOL
White White & Asian
 English/Welsh/Scottish/ Any other mixed/multiple African FEML
Northern Irish/British ethnic background Caribbean
Irish Asian/Asian British First steps to Employability
Any other Black/African/
Gypsy or Irish Traveller Indian Caribbean background
Functional skills
Any other White background Pakistani Other
Mixed/Multiple Ethnic Arab
English and maths
White & Black African Chinese Any other ethnic group Functional skills IT
White & Black Caribbean Any other Asian background IT qualification
Age 20 or under 21 - 29 30 - 39 40 - 49 50 - 59 60+ Leisure
Gender Disability Learning Difficulty STEM qualification
Male I have a disability I have a learning difficulty STEM no qualification
Female I do not have a disability I do not have a learning difficulty WFL
Thank you for completing this form.Your views and opinions are very important to us.

For office use only Inputted by Date

ACL Learner Feedback Form 2018/19 – V1
Please complete all sections of the form
(Ask your tutor for help if you do not understand any of the questions)
Do you know what you are going to do next? Yes /No
SECTION 1 Are you planning to do any of the following in the next six months?
(please tick)
Your Course Yes Partly No
 Further learning
Please tick    I am going to continue in the same subject to broaden my knowledge
 I enjoyed learning on my course I am going to continue in the same subject at the next level
 I am going to try something new
 I was happy with my tutor
 Volunteering  Employment
 I had the help I needed to achieve and make  Other – please state
good progress
 The tutor ensured that all learners showed SECTION 3
respect for others’ ideas and views It is important for us to know how being on the course helped
 The tutor listened to me and took note of in your personal development.
what I said Please tick all those that apply -
 Developed job related skills
 The tutor helped me to understand what I
can do next  Helped to be healthy and more independent
 Helped to feel safer and happier
 I felt safe in the classroom  Helped to feel more supported in and by my community
 Increased personal self-confidence
 I knew what to do if I or others did not feel  Improved social contact
safe on the course  Developed English skills
 Developed Maths skills
 I was informed about how to protect myself  Developed IT skills
from the risks associated with radicalisation  Increased awareness of how to stay safe online
and extremist behaviour
 Gained a positive attitude to learning

As part of your learning were any of the following included on
the course? (please tick all that apply)
 Computer  Tablet/Ipad  Internet Social Media
Smart Phone  Digital Camera