Application
Title
First Name(s)
Surname
Birth name (if different to current)
Home address (Street name & number)
Town
County
Postcode
Home Telephone
Mobile Number
Email Address
Date of Birth
National Insurance Number
Gender
Programme applied for
Before we can process your application we need to verify that you are eligible for SFA funding for it's Work Based Training for Young Peoples Programmes. Please confirm the following by selecting Yes or No. 
Before we can process your application we need to verify that you are eligible for SFA funding for it's Work Based Training for Young Peoples Programmes. Please confirm the following by selecting Yes or No. 
Before we can process your application we need to verify that you are eligible for SFA funding for it's Work Based Training for Young Peoples Programmes. Please confirm the following by selecting Yes or No. 
Are you a British or European (EU) National who has been a resident in Britain or the European Economic Area for three years.
If NO please give details of your residence status
Are you in full time education at school or FE College
Are you in Higher Education at an HE Institute or University
Have you completed year 11 of statutory school education
Do you intend on returning to full time education
It is possible we will need to contact you to clarify any issues we have to enable us to take forward your application
Name of the school / college you last attended
School address (Street name )
Town
County
What were your start and end dates for this School/College (Month & Year only)
Name of any previous training provider or College registered with
From
To
What course did you do?
Did you complete this course?
If no, why did you not complete this?
Have you used any learning platform previously, if so which ones?
Learners 19 -24  only
Is this your first NVQ course?
If YES, what is the reason for this?
If Yes, what are your reasons for starting an apprenticeship now?
Current Employment Details
Employer contact name
Position within company
Company name
Business address (Street name & number)
Town
County
Postcode
Date you started with this employer?
Telephone Number
Email Address
Website
How did you hear about the vacancy with your current employer?
Other please specify
Whose responsibility is it for finding models?
What are your practical training days and times
What are you typical agreed days of attendance
Total Number of hours a week
Does your job require tools and equipment
If YES who supplies it
Do you have a contract of employment?
What rest breaks do you receive?
How often are you paid?
Do you get a payslip
How much paid holiday do you get
Are you receiving the minimum wage for apprenticeships or higher?
Employment History
Equality and Diversity
Equality and Diversity
Ethnicty








Next of Kin
Please give your first contacts details in case of emergency
Please give your second contacts details in case of emergency
Additional Support


To ensure that we offer the best possible support to help you succeed, we require you to answer all of the questions below honestly.

Please provide as much detail in the comments box as possible.
 Please provide as much detail in the comments box as possible
 Please provide as much detail in the comments box as possible
Do you have a disability or condition, which restricts the kind of work you do, or for which you will require support?
If YES give details of how this restricts the work you do and provide information on support you will require
Is English your first language?
Will you require support for your Written Work
Will you require support with reading
Will you require any support with ICT?
Do you have any learning difficulties for which you will require support
If YES please give details
Do you have dyslexia
If YES, what support will you require
What additional support has been provided by previous school/college/provider
Additional Information
Health






Give details of any other health issues
If you have only selected one of the above does this have a significant impact on your work/training. If so please explain why and how
Have you had any recent or recurrent offending behaviour
If YES please give details
Do you have a criminal record
If YES please give details
Have you had poor or erratic attendance during your last year of full time education or have you been excluded/expelled from school or have no school record
If YES please give details
Household Situation
Is your home environment supportive (included carer/hostel)
Do you have any problems with any of the following





If YES please give details
Are you a parent or soon to be one
Do you have difficulties engaging in learning
Are you receiving counselling or support at the moment
If YES please give details
Are you on prescription medication?
If YES please give details
Are there any known side effects
Do you think of yourself as a vulnerable person
 
 
Signatures
Printed Name Signature Date Options
Learner Name Obtain Signature