SECTION 1 - LEARNER INFORMATION
Email
Title
Please Select...
Mr
Mrs
Miss
Ms
Dr
Rev.
Hon.
Mx
Other
Date of Birth (Date)
National Insurance Number
First Name
Last Name
Previous Surname
Gender
Please Select...
Male
Female
Nationality
Please Select...
United Kingdom
Ireland
Not Known
Afghanistan
Aland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Antarctic Territory
British Indian Ocean Territory
Brunei
Bulgaria
Burkina Faso
Burma
Burundi
Cambodia
Cameroon
Canada
Canton and Enderbury Islands
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, Democratic Republic
Cook Islands
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Czechoslovakia
Dahomey
Democratic Yemen
Denmark
Djibouti
Dominica
Dominican Republic
Dronning Maud Land
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
French Territory of Afars and Issas
Gabon
Gambia, The
Georgia
German Democratic Republic
Germany
Ghana
Gibraltar
Gilbert Islands
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See/Vatican City
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Isle of Man
Israel
Italy
Ivory Coast
Jamaica
Japan
Jersey
Johnston Atoll
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Midway Islands
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Hebrides
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine
Panama
Panama Canal Zone
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Vietnam
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Trust Territory of the Pacific Islands
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
Union of Soviet Socialist Republics
United Arab Emirates
United States
United States Minor Outlying Islands
United States Miscellaneous Pacific Islands
Upper Volta
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wake Island
Wallis and Futuna
Western Sahara
Yemen
Yugoslavia
Zaire
Zambia
Zimbabwe
Ethnicity
Please Select...
English / Welsh / Scottish / Northern Irish / British
Irish
Gypsy or Irish Traveller
Any Other White background
White and Black Caribbean
White and Black African
White and Asian
Any Other Mixed / multiple ethnic background
Indian
Pakistani
Bangladeshi
Chinese
Any other Asian background
African
Caribbean
Any other Black / African / Caribbean background
Arab
Any other ethnic group
Not provided
White Scottish
Black Scottish
Prefer Not To Say
Address
Address Line 2
Address Line 3 - CITY
Address Line 4 - Region / County
Postal code
Mobile phone number
Emergency Contact Details
Name
Relationship
Contact Number
SECTION 2 - PRIOR ATTAINMENT
Are you currently undertaking a learning programme/course that is government funded?
Have you attended any other Skills Bootcamp with any educational provider from 1st April 2023 to present?
Please select the highest level of qualification you have.
Please Select...
1: Entry level
2: Level 1
3: Level 2
4: Full Level 2
5: Level 3
6: Full Level 3
7: Level 4
8: Level 5
9: Level 6
10: Level 7 and above
97: Other qualification, level not known
98: Not known
99: No Qualifications
Do you have any prior qualification relating to the topic of your Bootcamp?
If you have a Level 6 qualification or above, please select from the drop-down in what field this was attained.
Please Select...
Health, Public Services and Care
Science & Mathematics
Agriculture, Horticulture and Animal Care
Engineering and Manufacturing Technologies
Construction, Planning & Built Environment
Information & Communication Technology
Retail and Commercial Enterprise
Leisure, Travel and Tourism
Arts, Media and Publishing
History, Philosophy and Theology
Social Sciences
Languages, Literature and Culture
Education and Training
Preparation for Life and Work
Business, Administration and Law
Prior Qualifications: If you answered yes, please provide the details of the prior qualification.
SECTION 3 - PROOF OF ELIGIBILITY FOR GOVERNMENT FUNDING
I confirm that I am a citizen of/have been resident in the UK or EEA member state continuously for at least the previous 3 years and that my residency has not been purely for the purpose of full-time education.
Please Select...
I can confirm this is correct.
I have not been a citizen/resident for at least the previous 3 years.
Please confirm your date of entry to the UK or other member state.
Are you ordinarily a resident in England?
EU Settlement Scheme Status (if applicable)
Please Select...
Pre-Settled
Settled
Indefinite leave to Remain
N/A
Do you have "indefinite leave to remain" or "settled status"?
Do you have official status as an Asylum Seeker?
Do you have official status as a refugee?
If you have an official status as an asylum seeker, please enter the date of application
Please ensure that you upload a copy of all relevant paperwork below, including passport and Home Office documentation where applicable.
SECTION 4 - EMPLOYMENT STATUS INFORMATION
Employment Status
Please Select...
In paid 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
Not in paid employment, looking for work and receiving benefits
Self-Employed
Employer Name
Employer Postcode
Job Title
Industry or sector of current occupation
Please Select...
Administrative and Support Service Activities
Agriculture, Forestry and Fishing
Arts, Entertainment and Recreation
Construction
Education
Electricity, Gas, Steam and Air Conditioning Supply
Financial and Insurance Activities
Human Health and Social Work Activities
Information and Communication
Manufacturing
Mining and Quarrying
Professional, Scientific and Technical Activities
Real Estate Activities
Repair of Vehicles/Motorbikes
Transportation and Storage
Water Supply, Sewerage, or Waste Management
Wholesale/Retail
Other Service Activities
Employed Hours
Please Select...
0-10 per week
11-20 per week
21-30 per week
31+
Length of Employment
Please Select...
Up to 3 months
4-6 months
7-12 months
12 months +
Please detail your current earnings
How often do you receive this amount?
Please Select...
Hourly
Weekly
Monthly
Yearly
Do you plan to work alongside the bootcamp?
Are you looking for work?
Are you available to start work?
Length of Unemployment
Please Select...
Less than 6 months
6-11 months
12-23 months
24-35 months
36 months +
What was your last job/occupation?
What sector was this in?
Please Select...
Accommodation & food
Agriculture, forestry & fishing
Arts, entertainment & recreation
Business admin & support
Construction
Education
Finance & insurance
Health & social care
IT & communications
Manufacturing
Mining & extractives
Other services
Professional & technical
Public admin & defence
Real estate
Retail & wholesale
Transport & storage
Utilities
What benefits are you in receipt of?
Please Select...
Job Seekers Allowance
Universal Credit (UC)
New Style Employment and Support Allowance (ESA)
Other state benefits
No benefit(s) received
Type of Business
Please Select...
Sole Trader
Partnership
Limited Company
Limited liability partnership
Community Interest Company
Industry or Sector
Please Select...
Administrative and Support Service Activities
Agriculture, Forestry and Fishing
Arts, Entertainment and Recreation
Construction
Education
Electricity, Gas, Steam and Air Conditioning Supply
Financial and Insurance Activities
Human Health and Social Work Activities
Information and Communication
Manufacturing
Mining and Quarrying
Professional, Scientific and Technical Activities
Real Estate Activities
Repair of Vehicles/Motorbikes
Transportation and Storage
Water Supply, Sewerage, or Waste Management
Wholesale/Retail
Other Service Activities
Self-employed hours
Please Select...
0-10 per week
11-20 per week
21-30 per week
31+
Length of self-employment
Please Select...
Up to 3 months
4-6 months
7-12 months
12 months +
Estimated annual income before tax
How will this Skills Bootcamp support your business?
If you are employed, has your employer sent you to attend this bootcamp?
Employer Contact Name
Employer Contact Email Address
Employer Contact Phone Number
Do you intend to seek a new job at a different employer (or become self employed), after finishing your Bootcamp?
Are you in full time education/training prior to enrolment?
If you are in full education / training prior to enrolment, please provide details.
SECTION 5 - SUPPORT & MENTORING
Do you consider yourself to have any special educational needs and/or disabilities?
Please select your most significant or primary barrier to learning
None
Emotional/behavioural difficulties
Multiple disabilities
Multiple learning difficulties
Vision impairment
Hearing impairment
Disability affecting mobility
Profound complex disabilities
Social and emotional difficulties
Mental health difficulty
Moderate learning difficulty
Severe learning difficulty
Dyslexia
Dyscalculia
Autism spectrum disorder
Asperger's syndrome
Temporary disability after illness or accident
Speech, Language and Communication Needs
Other physical disability
Other specific learning difficulty (e.g. Dyspraxia)
Other medical condition (for example epilepsy, asthma, diabetes)
Other learning difficulty
Other disability
Prefer not to say
Not provided
Do you have any unspent criminal convictions (excluding minor motor offences)?
How did you hear about us?
SECTION 6 - 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 upload it here.
COPY OF PROOF OF ID
Accepted forms of proof of ID include Passport, Driving License, 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 document.
COPY OF PROOF OF RESIDENCY
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 are an UK/ EEA resident, and if applicable this will need to cover the last 3 consecutive years.
COPY OF PROOF OF ADDRESS
Accepted forms of proof of address are Benefit Letter, Utility Bill, Payslip, Bank Statement (all dated within the last 3 months). Tenancy Agreement or Council Tax Bill/ Statement (dated within the last 12 months) and or Driving License.
Please contact us if you require additional information or assistance:
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