Enrolment form - Bracknell and Wokingham College

Enrolment form & Learning agreement
Please complete all relevant boxes and return to the address on page 3 of this form.
Remember you can enrol online for many courses at www.bracknell.ac.uk or call 0845 330 3343
1. Personal details (please write in BLOCK CAPITALS) - if this course is a present, please put the recipient’s details here
Have you previously enrolled with us?
Yes
Year
Address
details
No
Town
County
Email
First name
Last name
Postcode
Tel: Home
Title
Ms Mrs Miss Mr Other
M
F
If you have enrolled before using a different
surname, please tell us the name you used then
F
Tel: Mobile
Tel: Work
Please contact me about courses, events
or college closure by SMS/email
Yes
Date of birth D D M M
Y Y
Age (in years)
on 31.08.2014
Are you currently in full-time education?
Yes
No
Person to contact in an emergency
No
(if you are under 18, please give details of a parent/guardian who we may
also contact about your progress at college)
First name
National Insurance No.
Last name
Telephone
Unique Learner No. (if known)
Email
see notes of page 4 for this form.
Relationship
If any of your contact details change after you have enrolled please let us know as soon as possible.
2. Nationality
Your nationality – as shown on your passport
Have you always been a permanent resident
in the UK or other EU country?
Yes
In which country did you live before coming to the UK?
Date of entry to the UK
D D
M M
Y Y
No
If the answer to the above question is no, please complete the details on the
right (passport and immigration documents must be shown)
Are there any restrictions on the length
of your stay in the UK?
Yes
No
If yes, please state the restrictions
3. Course details
Course code
Centre Abbrev
Course title
Start date
Day (s)
Time (s) F
Tick this box if you are buying this course as a gift for someone. Put their details in section 1: Personal details
and your details in the section 10. Payment details.
Fee (£)
Office use
Total
4. Discount information for courses marked with
This section is only for those in receipt of benefit, see page 3 of
the guide for full discount eligibility information. See discount
icons key on page 4 of this form. Please tick the relevant benefit.
You will need to produce recent evidence of benefit - please note
JCP40 is not acceptable.
Are you in receipt of:
JSA
ESA/WRAG
L2
L3
Other benefit
U
Are you actively looking for work?
CL
Pension credits
Yes
No
If not employed: how many months have you been unemployed?
Fewer than 6
6–12
12–23
24–35
35+
Remember you can enrol online for many courses at www.bracknell.ac.uk or call 0845 330 3343
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5. Ethnic origin – the Government has asked us to record the ethnic origin of all students. Please complete this section
31 – White English/Welsh/
Scottish/Northern Irish/British
32 – White Irish
33 – Gypsy or Irish Traveller
34 – Other White background
35 – White & Black Caribbean
36 – White & Black African
43 – Other Asian background
44 – Black African
45 – Black Caribbean
46 – Other Black background
47 – Arab
98 – Any other ethnic group
37 – White & Asian
38 – Other mixed/multiple
ethnic background
39 – Indian
40 – Pakistani
41 – Bangladeshi
42 – Chinese
6. Additional support – The information in this section will be passed to your tutor
We would like to be able to support you in your studies.
Please tell us if you have any health, disability or learning needs which might impact on your course
If you have had any special examinations arrangements before, give brief details
If you look after someone with a long-term illness
or disability please tick this box
Please tick here if we may pass on your details to your local
Carers’ organisation which can help access the help available
The Equality Act 2010 states nine protected characteristics: age, disability, gender reassignment, marriage & civil partnership,
pregnancy & maternity, race, religion, sex and sexual orientation. If you feel we need to know any further information related
to any of these characteristics in order to meet your needs then please give details.
If you would prefer to contact the Student Services Manager direct, please email [email protected]
7. Qualifications already held – please tell us the highest qualification you have already achieved
We need to know this because you may be able to get your course free, depending on your highest qualification.
09 Entry Level
07 Other below Level 1
01 5 GCSEs, O Levels D–G, NVQ 1
No full Level 2 qualification
(5 GCSEs A*–C or equivalent)
02 5 GCSEs, O Levels A*–C, NVQ
2, GNVQ Int, 1 A Level
11 Level 5
03 2+ A Levels, 4 AS Levels,
NVQ 3, GNVQ Adv, C&G Adv
97 Other qualifications
10 BTEC HNC/D, Teaching quals,
NVQ 4, BA/BSc
99 No qualifications as of the
completion of this form
(higher level)
(unknown level)
8. Fee details – who is paying your fees? (you may tick more than one box)
If you are in paid employment are you:
Is your employer – paying the whole fee?
Self employed
Yes
No
Is your employer – contributing towards your fees?
Working for 16 hours or more per week?
Yes
No
Fees will be paid by you or other agencies?
9. For sponsors – only to be completed if someone else is paying for your course
Undertaking by sponsor: In accordance with the college’s
Conditions of Enrolment, we agree to meet the tuition fees
& examination fees as appropriate for the student named in
Section 1. Refunds will only be given as detailed in Section 10
and neither the student’s attendance, performance, continued
employment nor any other factor shall be cause for failure
to pay the fees. *Asterisked boxes mean the information is
mandatory – please complete all details in full
Name of person authorising payment*
Position in organisation*
Amount to be invoiced*
Signature of person authorising payment*
Name of sponsoring company or organisation*
Date signed*
Invoice name and address
M M
Y Y
Thank you for agreeing to pay for this student’s fees. If you do
not enclose a remittance with this form you will be invoiced.
Name*
Town*
Country*
D D
Purchase order attached
Postcode*
Company letter attached
Company stamp (please stamp here)
Email*
Tel No*
Fax No*
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10. Payment details - (please tick and complete where applicable)
24+ Loan
College Bursary
(I have/will be
applying for a loan)
(I have/will be
applying for a bursary)
Credit card/
debit card
(see below)
Cheque/postal order
Cash
(to Bracknell & Wokingham
College)
(do not send
cash by post)
Card number
Card start date
Card expiry date
Cardholder’s name (as shown on the card)
Issue no.
Cardholder’s address
Cardholder’s signature
Daytime telephone no.
If we have to cancel a course and cannot offer a suitable alternative you will receive a full refund. If you request in writing
to withdraw from a course more than four weeks before the course starts you will receive a refund of the course fee less
an administration fee. This fee is 10% with a minimum charge of £10 and a maximum of £250 per refunded course covering
administration costs and the loss of potential income to the college.
We are only able to grant refunds in exceptional circumstances which are in accordance with our refund policy. You can
find the full refund policy on our website (www.bracknell.ac.uk) or on request from our Enquiries & Admissions Centre.
Please write to the Student Services Manager, Bracknell & Wokingham College, Church Road, Bracknell RG12 1DJ or by
email to [email protected] to request a refund.
11. Declaration – please read all the information on this form carefully before signing
• I declare that all the information I have provided is accurate and that I have read and understood the statements relating to
Data Protection & Learning Agreement (shown on the next page), and ensured that all relevant boxes have been completed
• I authorise the college to provide appropriate information to my parent(s) or guardian(s) if under 19, or employer or
sponsor (if appropriate) on progress and attendance on courses for which I have enrolled, or in the event of any cause for
concern or medical emergency
• I agree to abide by the college’s policies and procedures
Please tick this box if you have enrolled on a funded qualification at another college or training provider within this academic year
Please sign here
Date
This activity may have been directly or indirectly part financed by the European Social Fund – helping develop employment
by promoting employability, business spirit and equal opportunities and investing in human resource.
12. Send back your form
Before returning this form please remember to:
• Include documentary evidence if you are a Jobseeker on benefits
• Include payment or payment details
• Sign in the box above
Return this form to:
Enquiries & Admissions
Bracknell & Wokingham College
Church Road
Bracknell
RG12 1DJ
24+ Advanced Learning Loan eligible course. There are
two fees shown for these courses: the first is the fee for
students 19–23; the second is the fee for students over 24
Up to 100% reduced tuition fee for Jobseekers
Level 2, full qualification
Community Learning
Level 3, full qualification
OFFICE USE ONLY
I confirm that I have given course guidance to this student
I confirm that I have checked this form prior to enrolling
Signed
Course Code
Enrolment form Inspirations.indd 3
Postal enrolment
Date
Input Clerk / Date
W
CC
T
Changes Recorded
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Data protection
Bracknell & Wokingham college will record and process personal data obtained from you or other people for the purposes
connected with your studies. Personal data includes attendance records, academic records, academic marks, grades and
coursework details. This information may be passed to statutory and awarding bodies and, where appropriate, parents,
carers, educational establishments and local education authorities, current and prospective employers (for example, for
references).
How we use your personal information
The personal information you provide is passed to the Chief Executive of Skills Funding (“the Agency”) and, when
needed, the Department for Education, including the Education Funding Agency to meet legal responsibilities under the
Apprenticeships, Skills, Children and Learning Act 2009, and for the Agency’s Learning Records Service (LRS) to create
and maintain a unique learner number (ULN). The information you provide may be shared with other organisations for
education, training and employment–related purposes, including for research.
Further information about use of and access to your personal data, and details of organisations with whom we regularly
share data are available at: http://skillsfundingagency.bis.gov.uk/privacy.htmv
Tick any of the following boxes if you do not wish to be contacted:
About courses/learning opportunities
By post
For surveys and research
By phone
By email
Learning agreement
You have certain responsibilities as a student. Please read, complete and sign this agreement. The college will keep this
form as part of your record.
• Comply with the Equality and Diversity Policy of the college, which includes respecting fellow students and staff, making sure
your actions do not hinder their responsibilities Find out more at www.bracknell.ac.uk/about_us/our_iag_policy.aspx
• Treat the college’s facilities, resources and equipment with care so that everyone can work in pleasant and safe surroundings
• Comply with college site regulations and Health and Safety procedures
• Attend timetabled classes punctually and submit any work set by the agreed deadline
• Refrain from supplying, trafficking or using any controlled drug or supplying or consuming alcohol on college premises
• Respect software licensing and not install or run unauthorised software on college computers and comply with any Copy
right Regulations
• Comply with the Student Code of Conduct that is displayed in all of the Bracknell & Wokingham College Centres. We can
send you a copy of the Student Code of Conduct, please call 0845 330 3343
Information, advice and guidance (IAG)
Bracknell & Wokingham College is committed to you and your future. We will give you clear, impartial information, advice and
guidance at every stage of your time with us. Students should have the following expectations from us:
• To be given impartial IAG to make an informed choice
about courses available at the college.
• To be given opportunities to develop appropriate
‘Employability Skills’.
• To be given appropriate information about the college,
its services, policies and procedures.
• To have access to impartial Careers IAG.
• To have access to IAG to help make informed choices in
terms of progression to other courses, training, employment
or higher education.
• To receive IAG about how to gain the maximum benefit
from the course.
Remember you can enrol online for many courses at www.bracknell.ac.uk
or call 0845 330 3343
OFFICE USE ONLY
Type of benefit evidence/proof
Employer
sponsor
Verfied by staff
Eligible for the entitlement to:
6 1
Level 2
Level 3
Emp status
at start
Copy attached
EFA/SFA
fund
REM
code
Col
code
Fair processing notice
Ability to share:
FPN not seen
FPN seen & able to share
FPN seen & unable to share
Verification:
None provided
Driving licence
National insurance card
Relationship with school
Bank/debit/credit card
Other
Passport
ID card
Date Received
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Person Code
ULN
Input By
Audited
Checked
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