Learner Details:
                                           
The name you supply will be used on any certificates and correspondence from Professional Training Solutions (PTS) Ltd, so please state your legal name, NOT a preferred name or nickname.

Please ensure that you give an email address that you check on a regular basis.  Please note that we are unable to fund anyone that lives in the Greater London Area.
First Name:
Surname:
Title
Middle Name:
Date of birth
Gender
Email Address:
Mobile Number:
Address 1:
Address 2:
Address 3:
Post Code:
National Insurance Number :
Please tick the relevant house hold situation:


Employment Information :
Employment Status:
If unemployed, please tick all relevant statements:
If employed, please provide your employers name and address:
How many hours per week do you work?
How long have your worked there?
Emergency Contact Details :
Contact Name
Contact Number of Emergency Contact
Relationship to Emergency Contact
Ethnicity & Nationality :
Please select the appropriate ethnic group:
What is your nationality?
Education:
Please state what prior qualifcations you have and the grade, including English and maths:
Are you on any other Government Funded training course i.e. Apprenticeship etc?

Contact Methods :
Please state your preferred methods of communication (you can give more than one):
Residency :
Have you lived in the UK or EEA for at least the last 3 years?
Disability & Health Information:
Please select the appropriate answer with regards to disability: (Physical Disability, Visual Impairment etc)
Please give any further details on your disability that you wish :
Course Details :
What qualification are you applying for?
How did you hear about the course? i.e. website, friend, facebook etc.
Benefits:
Please declare which state benefits you are receiving (please tick all relevant boxes):


If your benefit is not listed above, please state what other benefit you are receiving:
Declaration:
Privacy Notice / General Data Protection Regulation 2018 PTS Ltd will hold your personal information in accordance with the General Data Protection Regulation 2018. At no time will your information be passed onto third party organisations for sales and marketing purposes. The personal information you provide will be given to the Education & Skills Funding (“the Education & Skills Funding Agency”) and the Department for Business, Innovation and Skills (BIS). Where necessary it is also shared with the Department for Education, and Local Authorities (LA’s). The information is used for the exercise of functions of these government departments and to meet statutory responsibilities, under the Apprenticeships, Skills, Children and Learning Act 2009, and to create and maintain a Unique Learner Number (ULN) and a Personal Learning Record (PLR). The information you provide may be shared with other organisations for education, training, employment and well-being related purposes ONLY, including for research. If this is a Government funded course either through the Education & Skills Funding Agency (ESFA) or Local Authority (LA) it could also be eligible for match funding and can therefore be partly funded by ESF (European Social Fund). You may be contacted after you have completed your programme of learning to establish whether you have entered employment or gone onto further training. Further information about use of and access to your personal data, and details of organisations with whom we regularly share data are available at: https://www.gov.uk/government/publications/esfa-privacy-notice. Further information about our Privacy Notice can be found here.

By selecting ‘Agree’ below, you confirm that all the information given on this form is correct. You also understand that should the information have provided be found to be false PTS Ltd may take necessary steps against you to recover all tuition fees and any other costs associated with your learning. You also agree to abide by our terms and conditions which are found here.

 
 
Signatures
Printed Name Signature Date Options
Learner Obtain Signature