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Enrolment Form

Your Course(s)

Course NameStart DateEnd DateSite
(ACL) Using Essential Digital/IT Skills09/10/202404/12/2024Enfield Centre

Personal Details

Further Details

Employment

Terms

Personal Details


Title
First Forename (This must be your legal name)
Middle Name(s)
Surname
Known As Name (what we should address you as)
Legal Sex
Preferred Pronoun
Date of Birth
Unique Learner Number

Nationality
Have you seen evidence of the student’s nationality and current right to live in the UK? (required for adult learners whose nationality is not British, and who live in the West Yorkshire Combined Authority (WYCA) area
Ethnicity
What is your country of residence
What is your first language?
Will you have lived continuously in the UK for at least 3 years on the first day of your course?

Answer yes to the above if you are 16 to 18 (or 19-24 with an Education, Health and Care Plan), are living legally in the UK and have been ordinarily resident (living legally) in the UK and Islands (that is, including the Channel Islands and the Isle of Man) for the 3 years preceding the 1st September 2023, for purposes other than education.

Answer yes to the above if you are aged 19 or over, are living legally in the UK and have been ordinarily resident (living legally) in the UK and Islands (that is, including the Channel Islands and the Isle of Man) for at least the previous 3 years on the first day of learning, for purposes other than education

If you have answered “No”, please complete the Eligibility Form

Date of Entry into the UK

Date of first entry into the UK. Please give the date when you entered the country to live here. If you are not currently living in the UK, please enter the date you expect to enter the UK to start your course


Contact Details


Mobile

Tick for YES - leave blank for NO

Email Address
Email Address (enter again)
     

Tick for YES - leave blank for NO

Address

Please enter your postcode or partial address below:

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Search Results


Property/Street
Locality
Town
County
Years at this address

Tick for YES - leave blank for NO


Is your term time address different to your home address?

Term Time Address

If you are living away from home during your studies, please provide the details of your Term Time address below

House number / Street name
Area
Town/City
County
Have you seen evidence that the student lives in West Yorkshire? (required for adult learners who live in the West Yorkshire Combined Authority (WYCA) area

Emergency Contact/ Next of Kin

Primary Contact

Emergency Contact Name
Emergency Contact Relationship
Emergency Contact Phone number
Emergency Contact Email Address

Tick for YES - leave blank for NO


Secondary Contact

If you are under 19, we require two emergency contacts. If you do not have anyone who can act as a second emergency contact please tick below:

No secondary contact

Tick for YES - leave blank for NO

Emergency Contact Name
Emergency Contact Relationship
Emergency Contact Phone number
Emergency Contact Email Address

Learning Support

Do you have any disabilities or learning difficulties?

Do any of the below questions apply to you?

Luminate Education Group offers a range of support services for students and if you select any of the options below we will discuss confidentially any support you may require

Do you have an Education Health & Care Plan?
Would you like to speak to a member of staff regarding Learning Support?