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Direct Enrolment Form

Your Course(s)

Course NameStart DateEnd DateSiteFees
Pottery Throwing and Projects Evening - Wednesday Evening Block 208/01/202502/04/2025Newark Campus£130.00

Personal Details

Mandatory fields are marked with a

National Insurance No.
Title
First Forename
Middle Name(s)
Surname
Have you ever been known under a different surname?
Previous Surname
How do you prefer to be known? (optional)
Sex
Date Of Birth
Mobile
Can we call/text you on this number?

Tick for YES - leave blank for NO

Email Address
Can we write to you at this email?

Tick for YES - leave blank for NO

Home Telephone
Are you currently studying at another provider?

Tick for YES - leave blank for NO

Nationality, Equality and Diversity

Nationality
Ethnicity
What is your country of residence
What is your first language?
Will you have lived continuously in the UK for more than 3 years on the first day of your course?

If you have not been a resident of the UK for 3 years you may not be entitled to funding - we will need to collect more information from you to determine your eligbility

Visa Type
Date of Entry into the UK (If non UK or EU resident)
Visa Expiry Date

Address

House number and street name
Address Line 1
Town/City
County/District
Postcode
Years at this address
Can we write to you at this address?

Tick for YES - leave blank for NO

Previous Qualifications

What is your highest level of Qualification?

Use the following table to help you pick the correct qualification level...

LevelAcademic Qualification Equivalent
Entry Level first certificate GCSE - grades 3, 2, 1 or grades D, E, F, G level 1 award level 1 certificate level 1 diploma level 1 ESOL level 1 essential skills level 1 functional skills level 1 national vocational qualification (NVQ) music grades 1, 2 and 3
Level 1 For example, GCSE grades 1-3/F-D, First certificate, Level 1 Award/Certificate/Diploma, Functional Skill Level 1
Full Level 2 GCSE/O Level (5 or more GCSEs grades A*-C), GCSE (9-1) (5 or more GCSEs grade 4 or above), 2 or 3 AS Levels (for AS qualifications regulated before 1 September 2015), CSE Grade 1 (5 or more), 1 A Level, Higher 14-19 Diploma, QCF Diploma level 2, QCF Certificate level 2 at 13 or 14 credits undertaken before 2014 to 2015, Level 2 Principal Learning, NVQ level 2, GNVQ Intermediate,
Full Level 3 A Levels (2 or more advanced level passes), 4 or more AS Levels (for AS qualifications regulated before 1 September 2015), QCF Diploma Level 3, QAA Access to HE, Advanced 14-19 Diploma, GNVQ Advanced, NVQ level 3, AVCE double award, Tech Levels which are in the 16-19 Performance Tables, Applied Generals which are in the 16-19 Performance Tables (from 1 August 2015), QCF Certificate at Level 3 which is 30 to 36 credits
Level 4 For example, Certificate of Higher Education, Higher Apprenticeship, HNC
Level 5 For example, Diploma of Higher Education, Foundation Degree, HND
Level 6 For example, Degree Apprenticeship, Honours Degree
Level 7 For example, Masters level degree, PgDip
Level 8 For example, Doctorate/PhD

Photo - For your ID Card

Please upload a clear headshot, for iPhone users - make sure the photo is rotated the correct way round

You can take a photo with a digital camera or smartphone, upload a photo from a device or from Facebook, or scan in a paper photo

Acceptable PhotosCommon Mistakes

You can drag and drop files here, or click 'choose file' to upload from your device:

NOTE: only JPG, JPEG, PNG and GIF files are allowed, 4MB maximum

Emergency Contact / Next of Kin

Primary Contact

Emergency Contact Name
Emergency Contact Relationship
Emergency Contact Phone number
Emergency Contact Email Address
Are you living with this person?

Tick for YES - leave blank for NO

Support & Safeguarding

Do you have any disabilities or learning difficulties?
Do you have an Education Health & Care Plan?
Do you have any criminal convictions or are you currently under Police investigation?

You only have to disclose convictions where these are not spent under the Rehabilitation of Offenders Act 1974. If you are unsure if your conviction is spent you can check on the NACRO website at: nacro.org.uk. A custodial sentence of four years or more will never be spent. If you are applying for a course which will involve working with children (under 18) or vulnerable adults then you will have to declare all convictions including cautions and reprimands. These activities are exempt from the Rehabilitation of Offenders Act 1974.

Any failure to disclose criminal convictions, criminal investigations or prosecutions that you are subject to may result in you being removed from your course.


Are you a looked after Young Person?

Please tick if you are a Local Authority Looked After Child (16-18), Recent Care Leaver (18-25), unaccompanied asylum seeker or previously care experienced(e.g. in foster care, supported lodgings, residential care, special guardianship, in receipt of leaving care services or adopted)

Tick for YES - leave blank for NO

Employment

Employment Status
Are you Self-Employed?
How many hours per week?
How long have you been employed?
Employment Start Date
Is your annual gross salary less than £20319?

If you have answered Yes to this question, please can you upload three payslips on the next page - the dates must be within 3 months of your start date. If you are self-employed, please upload your annual tax return.

Length of Unemployment
Unemployment Start Date

If you are in receipt of benefits, please choose the type of benefit from the drop-down below, if none apply please leave blank:

Benefit Status

Please indicate if you are in receipt of any of the other state benefits below:

Attendance Allowance
Bereavement Allowance
Carer's Allowance
Child Tax Credit
Disability Living Allowance
Guardian's Allowance
Housing Benefit
Incapacity Benefit (from the 29th week you get it)
Income Support
Industrial Injuries Benefit
Lump-sum bereavement payments
Pension Credit
Pensions paid by the Industrial Death Benefit Scheme
Personal Independence Payment (PIP)
Severe Disablement Allowance
State Pension
War Widow's Pension
Widow's Pension
Widowed Parent's Allowance
Working Tax Credit

Is your take home pay (disregarding Universal Credit payments and other benefits) less than £494 a month (sole adult in the benefit claim) or £782 a month (joint benefit claim with partner?)

Will this course help you gain skills to enter employment or a more sustainable employment?

If you are not taking this course to gain skills to enter employment, you may be liable for fees.