Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Eligibility for free courses check *

All three criterion need to be met to receive the course for free. Evidence will be required in form of photo I.D & income proof or up-to-date benefit entitlement letter

I confirm that as of 31.08.2024 I am 19 or older

I confirm that I live in Lincolnshire

I confirm that I have a personal income of under £25,000 OR I receive state benefits

I am not eligible for funding - I wish to pay for my studies (invoice will be sent upon receipt of enrolment form)

Do you have a learning difficulty or disability *

Yes

No

Please select all that apply

Vision impairment

Hearing impairment

Disability affecting mobility

Profound / complex disabilities

Social and emotional difficulties

Mental health difficulties

Moderate learning difficulty

Severe learning difficulty

Dyslexia

Dyscalculia

Autism spectrum disorder

Asperger's syndrome

Temporary disability after illness / accident

Speech, language & communication needs

Other physical disability

Other specific learning difficulty

Other medical condition

Other learning difficulty

Other disability

Prefer not to say

GCSE (or equivalent) achievement *

Yes I have GCSE A*-C / 4-9 in English

No I do not

Yes I have GCSE A*-C / 4-9 in Maths

No I do not

Application for a free course / reduced fee *

Please confirm your situation to confirm your eligibility to concessions. You will need to provide proof of this in the upload box below these options.

I am in receipt of Employment and Support Allowance (all categories)

I receive Job Seekers Allowance

I receive Universal Credit

I am in receipt of other State Benefits

I earn less than £25,000 per year

I am unemployed and in receipt of state benefit and wish to enter employment

I do not have a full level 2 (5 GCSEs at grade C or above or 4-9/up to 3 AS levels)

I was aged over 65 on or before 31.08.2023

I am an offender serving my time in the community

I am an asylum seeker in receipt of the equivalent of income-based benefit (assistance under the terms of the Immigration and Asylum 1999)

Privacy notice *

Your information may be used for research purposes on behalf of the DfE and the ESF.

You can contact me about courses or learning opportunities

For surveys and research

You can contact me by post

You can contact me by email

You can contact me by phone

I do not wish to be contacted

Learner declaration *

All boxes must be ticked to ensure enrolment is processed

I agree to comply with all health and safety requirements and that the provider reserves the right to deny access if I fail to comply

I understand and accept that the Learning Service may have to change, or close, or combine classes, if a class is not available

I have been ordinarily a resident in the UK, EU, Iceland, Liechtenstein, Norway or Switzerland for the past 3 years

I agree to follow the Learner Code of Conduct

I understand that I am required to provide documentary evidence in support of any fee reduction that I am claiming with my application

I declare that the information on this form is correct and that I am 19 years, or over, on or before the 31/08/2024

Date of enrolment (todays date)

MM

DD

YYYY

Where did you hear about our training opportunities *

Web search

Social media

Careers fair

Public event

Referred by employment advisor (DWP/NHS)

Word of mouth