Vision2Learn

ENROLMENT FORM
2021-2022 Funding Year
Section 1 – Your Personal Details

1. Surname: Tingwa 2. Forename: Martha 3. Middle Name(s):

4. Title: Miss 5. Sex: Female 6. Previous Name(s):

7. Date of birth: 09/07/1999 8. Age on 31/08/2021:

9. Address Line 1: Juba

10. Address Line 2:

11. Address Line 3: Juba

12. Address Line 4: south Sudan

13. Postcode: GU16 7HF 14. Email: marthaoka728@gmail.com

15. Telephone Number: 16. N.I Number:

Section 2 – Prior Attainment

Are you currently undertaking a learning programme/course that is government funded?

Yes No

1. Please select the highest level of qualification from the drop-down list:
Select...

Section 3 – Your Choice of Course

Title Learning aim Start date End date

IAO Level 2 Certificate in IT User Skills (ITQ)
(QCF) 600/7550/8

NB – Your start and end date will be confirmed by email once you have started the course.

Why have you decided to enrol onto this course?

Section 4 – Proof of Eligibility of Government Funding

1. I confirm that I am a citizen of/have been resident in the UK or a member state of the EEA
continuously for at least the previous 3 years on the first day or learning and that my residency
has not been purely for the purpose of full-time education Yes No
2. If the answer is NO, please enter your date of entry to the UK or other member state of the
EEA:

3. Are you ordinarily resident in England? Yes No (please specify)

4. What is your nationality, according to your passport? Select...

5. EU Settlement Scheme Status (if applicable)

Applied, awaiting notification Share Code

Pre-Settled

Settled

6. Do you have “indefinite leave to remain” or “settled status”? Yes No

7. Do you have a Visa? Yes No

8. Do you have official status as an Asylum Seeker? Yes No

9. If the answer above is Yes, please enter the date of application:

10. Do you have official status as a Refugee? Yes No

Please ensure you upload a copy of all relevant paperwork, including passport and Home Office
documentation
Section 5 – Employment Status Information

1. Current Employment Status:

In paid employment
Do you earn less than £8.91 per hour? Yes No
Hourly Rate:
Employed hours:
Length of employment:

Self-employed
Self-Employed hours:
Length of self-employment:

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
Length of unemployment:

I confirm the above employment status information is correct.

Learner signature: Date:

Self-declaration for unemployed applicants who want to enter employment and need skills
training

 I am in receipt of one of the following benefits:

Job Seekers Allowance (JSA), including those receiving National Insurance credits only

Employment Support Allowance

Universal Credit

None of the above

I confirm the above benefit information is correct.

Learner signature: Date:

Please ensure you upload evidence of the benefits you receive in section 7
Section 6 – Support & Monitoring

1. Do you consider yourself to have any special educational needs and/or disabilities?
Yes No

If yes, please tick each box that relates to you. Any information given will be treated in
confidence.

10 Moderate learning difficulty 4 Vision impairment

11 Severe learning difficulty 7 Profound complex disabilities

12 Dyslexia 5 Hearing impairment

13 Dyscalculia 6 Disability affecting mobility

94 Other specific learning difficulty (e.g. 16 Temporary disability after illness

ADHD, dyspraxia) (i.e. post viral or accident)

14 Autistic spectrum disorder 17 Speech, language and

communication needs

15 Asperger’s syndrome 93 Other physical disability

8 Social and emotional difficulties 95 Other medical condition (e.g.

epilepsy, asthma, diabetes)

9 Mental health difficulty (e.g. depression, 97 Other disability

acute anxiety)

96 Other learning difficulty 98 Prefer not to say

2. Do you require any support during your studies? Yes No

Please provide details of what support you require:

4. Ethnicity: Select...

5. Household Situation (Select all that apply)

No member of the household in which I live (including myself) is employed

The household that I live in includes only one adult (aged 18 or over)

There are one or more dependent children (aged 0-17 years or 18-24 if full time student
or inactive) in this household

None of these statements apply

I wish to withhold this information

 Section 7 – Evidence Documents

Please upload any required documents. If you follow the link using your mobile phone/tablet you
will be able to take a picture and it is uploaded here:

✔ Copy of Proof of ID
Accepted forms of proof of ID are: Passport, Driving Licence, Birth certificate.
If your name is different from the name on your proof of ID, please also attach a copy of your
Marriage Certificate or Deed Poll.

Copy of Proof of Benefits

Accepted forms of proof of benefits are: Benefits Letter which is less than two months. Universal
credit evidence must clearly state your name, address and date and amount of payment.
or Copy of payslip (less than two months old)

or Copy of Current Contract of Employment

Copy of Proof of Residency Status

Accepted forms of proof of residency status include: Passport, Visa, Home Office Document or other
evidence of your residency status. Please note that your evidence must show that you have been an
UK/EEA resident for the last 3 years.
Section 8 – Declaration, Consent to Process and Acceptance of Terms and
Conditions

Privacy Notices
How the ESFA will 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 personal 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 Authority (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 for other purposes by ticking any of the following boxes:

About course or learning opportunities By post

For survey and research By phone

By email

By SMS

For 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

Learning Record Service (LRS) Privacy Notice

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 Northern Ireland, and is
operated by the Education and Skills Funding Agency, and executive agency of the Department for Education
(DfE). For more information about how your information is processed, and to access your Personal Learning
Record, please refer to; https://www.gov.uk/government/publications/lrs-privacy-notices
Learner Declaration
Please read the following statements:

 I confirm and understand that I am aware that the vision2learn course is an ESFA funded
programme which could be used as match funding for ESF which means the programme may
be part-financed by the European Union through the ESF which supports activities to extend
employment opportunities and develop a skilled workforce
 I confirm, that if any time before my course finishes, my personal circumstances change
from those provided in this enrolment form I will notify the training provider (Capita)
 I agree to Capita storing, processing and sharing (with external parties associated with the
learning programme detailed in this agreement) personal data contained in this form, or
other data including electronic photographic images, which the training provider may obtain
from me or other people, whilst I am a learner. I agree to being contacted by
phone/SMS/email and to the processing of data for any purposes connected with my
programme. For information on Capita’s privacy statement, please refer to:
https://www.capita.com/privacy-notice/
 I confirm that I believe that this course will help me move into work or progress into more
sustainable employment.
 I confirm I have read and understand the ESFA and LRS Privacy Notice

I confirm that the information provided on this form is accurate and correct.

Learner signature: Date:

I confirm that prior to processing this enrolment form, I will be responsible for checking all evidence you
have provided to support your eligibility for funding.

Training Provider signature: Date:

GUIDANCE

Tips for completing your online enrolment form

 Click the yellow ‘Next’ arrow on screen to navigate to the next field (question) in the
application form.
 There may be some sections of this enrolment form which are not relevant to your
application. You are not required to complete these sections. The best way to
identify the relevant sections is to use the navigation function described above, as
this is set up to bypass fields which are not required.
 At the top right of the screen you will see a small blue square button. This shows the
number of required fields that you have left to complete. Click this small blue
square button to navigate to the next required field in the application form. Please
note this function is not visible on many smartphones and tablets.
 Hover the mouse over the same blue square button. If there is an error in the form this will
display red text which says “fix 1 (or more) error(s)”. Click on this to move to the first error.
 If you need to use your phone to take a picture of ID you can return to your form on there

If you have any questions please call us on 0191 215 4100 between 9am–8pm Monday to
Thursday, 9am–5pm Friday and 10am-3.30pm Saturdays (excluding Bank Holidays).

Proof of ID

Please attach a digital copy of one of the following:

 Passport
 Driving Licence
 Birth Certificate

Your application cannot be processed without this proof of ID.