Apprenticeship Enrolment Form
The Enrolment Form and Individual Learning Plan (ILP) documents your journey as a learner and will record all
aspects of your progress through your qualification and your contact with your learning provider.
All the sections are designed to ensure you, the learner and your employer have as much direct participation in this
process as possible, and that you are given opportunities to explore any existing training needs as well as potential
paths for future training and/or career prospects.
Section 1: Learner Details (Please complete using BLOCK capitals and BLACK ink)
Title
Full Name
Last Name
Date of Birth
Age Group
NI Number
16-18
 19-24
25+
Postcode
Home Address
Borough/ County
Mobile Number
Home Number
Preferred Email
Emergency Contact
Relation to you
Emergency Contact No.
Emergency Contact
Email
Job Title
Unique Learner Number
Apprenticeship
Framework
Level
 L2
D
M
M
Y
 L3
Planned End
Y
Date
 L4
Learning Start Date
D
Contract Type
24+ Loan
QCF
Apprenticeships (19+)
Apprenticeships (16-18)
Funding
 Co-funded
 Fully Funded
English (Functional Skills)
Math’s (Functional Skills)
ICT (Functional Skills)
 24+ Loan
 0-16 Hours
 20+ Hours
 16-19 Hours
 30+ Hours
Hours per week
Employment Intensity
Indicator
Please specify hours

Contract Type
 Permanent
D
D
 L5
M
 Temporary
M
Y
Y
 Self-employed
Section 2: Employer Details
Employer Name
Contact
Job Title
Sector
Postcode
Employer Address
(Where the learner
is employed)
Email Address
Manager’s Telephone
No.
Apprenticeships (created 13/05/16)
Borough
Employment Start
Date
1
D
D
M
M
Y
Y
Length of
Employment
 Up to 3 Months
 4 - 6 Months
 7 - 12 Months
Length of unemployment
prior to course if applicable
 Up to 3 Months
 4 - 6 Months
 7 - 12 Months
Number of Company
employees
 More than 12
Months
 More than 12
Months
Number of Site
employees
Employer
Contribution
ERDS Number
£
The Employer contact as stated above will be contacted by the Skills Funding Agency to confirm your company
status. This occurs in order to ensure funding is available to your organisation.
Section 3: Equality & Diversity
Please tick which of the following best describes your ethnicity:






White British
(31)
White Irish
(32)
White Gypsy or Irish Traveller
(33)
Any other white background
(34)
White and black Caribbean
(35)
White and black African
(36)






Pakistani
(40)
Bangladeshi
(41)
Chinese
(42)
Any other Asian Background
(43)
African
(44)
Caribbean
(45)
(46)

White and Asian
(37)

Any other Black / African / Caribbean
Background

Any other mixed / multiple ethnic
background
(38)

Arab
(47)


Indian
(39)


Any other ethnic group
(98)
Not provided
(99)
Learning Support
Disability is defined by the Disability Discrimination Act as;
A physical or mental impairment, which has a substantial and long-term adverse effect on a person’s ability to carry out normal day-to-day
activities. The disability could be physical, sensory or mental and must be expected to last at least 12 months.
We provide a range of support for learners who have disabilities and learning difficulties. Whether or not you require support, please provide the
following information:-
a. Do you consider yourself to have a disability,
Yes
health problem or learning difficulty?
 No
Prefer not to say
b. If you answered ‘Yes’ and you have a disability or health problem, please tick (Disability)



Visual impairment
Profound complex disabilities
Disability affecting mobility




Other physical disability

Temporary disability after illness (e.g. post-viral) or
accident

Other medical condition (e.g. epilepsy, asthma,
diabetes

Not known / Information not provided


Emotional / Behavioural difficulties

Other
Hearing impairment
Mental health difficulty
Asperger’s syndrome
Multiple disabilities
___________________________________
Learning Difficulty:









Moderate learning difficulty
Severe learning difficulty
Dyslexia
Dyscalculia
Autism spectrum disorder
Multiple learning difficulties
Other
Not known / Information not provided
Other specific learning difficulty ____________________________________________________
Apprenticeships (created 13/05/16)
2
Wandsworth Council are committed to promoting fairness and eliminating discrimination. We will ensure
that no Apprentice receives less favourable treatment either directly or indirectly, on the grounds of age, race,
disability, gender, marital status, religion or faith or sexual orientation.
Do you consider
Male
Female
Transgender
yourself:
How would you describe your religion or belief?









Christian
Muslim
Buddhist
Sikh
Jewish
Prefer not to say
None
Other (Please Specify Below)
Hindu
Which of the following best describes your sexual orientation?






Heterosexual
Bi-sexual
Gay
Lesbian
Prefer not to say
Other
Prior Qualification Details – indicate the level of prior qualifications.
Recognition of Prior Qualification – Include QCF, Technical Certificates, Licences and Key Skills.
Provide details of the highest Qualification(s)
Award & Awarding
Certificate
RPL
Date
Evidence Seen?
Calculation
Body
Achieved
Prior Qualification Details – indicate the level of prior qualifications.

Entry Level
(09)

QCF Level 4 or a Degree
(10)

Other Qualifications below Level 1
(07)

QCF Level 5 or Post Graduate
(11)

QCF Level 1 or fewer than 5 GCSE
grades A-C
QCF Level 2 – 5 or GCSE grades AC
QCF Level 3 - 2 or more A Levels
equivalent
(01)

Other Qualification, Level Not Known
(97)
(02)

Not Known
(98)
(03)

No Qualifications
(99)


LEARNING AND DEVELOPMENT
Please tick the main reasons for undertaking a training programme: *








Getting a job
Improve my job / promotion
Earning more money
Getting better qualifications
Apprenticeships (created 13/05/16)
3
Gain a qualification to prove my knowledge
Improve skills such as writing and numbers
For interest and pleasure
My employer requires me to
I prefer the following method of learning: *







Attending traditional classroom based courses – group session
Distance learning – non facilitated learning
E learning – internet based learning
Reading journals / publications – continuous updating of knowledge
One to one session in the workplace – from external facilitator
Learning on the job – working alongside a work colleague
Facilitated network events – specialist facilitators / networking with managers
The best time for me to learn and study is: *


Mornings

Evenings
Afternoons

Weekends

Full day sessions
Are you enrolled on a course elsewhere?
Yes
 No
Section 4: Initial Assessment & Diagnostic Summary:
Assessment Method
Date of
Level Required:
Used:
Test:
Literacy
EL L1 L2
Level Achieved:
L3
EL
L1
L2
L3
Numeracy
EL
L1
L2
L3
EL
L1
L2
L3
ICT
EL
L1
L2
L3
EL
L1
L2
L3
Would additional Literacy and/or Numeracy support help you to move on?
Your Provider would like to offer you a chance to develop your skills and achieve your in literacy and numeracy
skills. A national certificate in Adult Literacy and Numeracy Level 2 is equivalent to a GCSE in English and Maths.
If you would like to work towards achieving this national qualification or any other support, please indicate by (√)
ticking the appropriate box:
Literacy
Dyslexia
Numeracy
Other (please specify):
Language
Additional learning
needs support required
Yes
No
(ALN)?
Additional support needs accommodations:
No support requested
Additional social
needs (ASN) support
required?
Yes
No
Preferred Learning Style: please enter the result
Visual Learner
Auditory Learner
Kinaesthetic

(prefers images)
(prefers
Learner (learns
words/sounds)
by doing)
Skills Scan Complete
Yes Copy of Initial Assessment & Skills Scan must be submitted
Apprenticeships (created 13/05/16)
4
Section 5: Eligibility & Declarations
Eligibility - Please tick each of the following statements to confirm whether you are eligible for government
funding to subsidise your learning:


I am currently not attending school, FE College or University as a student *
I am normally resident in the UK and islands or any EU Country and have been for the past 3 years and I can
provide evidence of this *
The Learner will need to supply evidence of residency or right to work in the UK

I will be over 19 years of age at the start of my chosen learning programme *
 I confirm that the above statements are accurate and true and I declare that I have correctly identified my prior
qualifications. I understand that if I have declared false information my learning provider may take action to
reclaim tuition fees and any support costs provided *
Yes
 No
Does the learner have a contract of employment?
 Yes
No
Is the learner paid at least minimum apprentice wage allowance?
 Yes
No
Is the learner working towards another qualification?
If ‘yes’, please state:
Residency (This must be met before you start the programme)
What is your nationality? (Not ethnicity)
For UK and EU nationals, please answer questons A and B.
For Non UK or EU nationals, please answer C, D, and E.
For UK and EU nationals
A. Have you been resident in the UK or an EU country for
the last 3 years?
 Yes

No
B. Please provide the following to confirm eligibility:
 Passport Number/EU ID*
If you are a UK citizen but do not have a passport,
please provide a copy of:
 Birth Certificate
* Non-British EU nationals must have a copy of their ID retained on
file.
For Non UK or Non EU nationals
C. Have you been resident in the UK for the last 3 years?
 Yes, Resident status:
E. Please provide the following to confirm eligibility,
evidence must be retained on file:
 No
 Valid Visa
(Attach copy)
If date of issue on visa is less than 3 years prior to
enrolment date, one of the following should also be
provided (attach copy):
C. Date resident in the UK (Approx.):
D
D
M
M
Y
Y
 Home Office Letter
 Immigration and Nationality Department Letter
 Visa
Eligibility check statement for Trainer / Assessor / Account Manager:
I confirm that I have checked this candidate’s passport / identification evidence and the above information is
correct.
Provider signature
Apprenticeships (created 13/05/16)
Date
5
D
D
M
M
Y
Y
LEARNER COMMITMENT (QCF and Apprenticeship) *
YOU AGREE TO:
















Make a positive commitment and contribution to your own learning and development.
Undertake all training and learning as agreed in your Individual Learning Plan.
Attend all assessments and training sessions as agreed, on time and notify absences in good time. (There is a clear link
between attendance and success. We may contact you if you are absent to see if we can help you overcome any barriers to
learning you are experiencing).
Be punctual and inform your Assessor if there is any reason why you are unable to attend at the agreed times.
Inform your Assessor promptly of any issues or concerns that may affect your learning or completion of your programme, in
order that we can provide any necessary help and support.
Contribute to and take an active role in your progress reviews.
Provide a range of evidence requested on time and meet agreed targets for achievement.
Observe the health and safety requirements of the programme and your responsibilities under the Health and Safety at Work
Act 1974.
Co-operate with your employer on Health and Safety matters and only use equipment that you have received adequate
training on safe use, and always use the equipment in a safe manner.
Treat staff, fellow learners and others with courtesy and respect. Not to behave in a way which is likely to cause offence,
discriminate against or cause harm to others, or bring the provider into disrepute.
Respect the beliefs, values and cultures of others.
Provide your Assessor with any medical information that they may need to know about you.
Report any accidents in the classroom to your Assessor immediately.
Bring all necessary course materials with you to each meeting/training session.
Contribute to learner feedback and consultation to help us improve our services.
Abide by and accept my responsibilities with regards to all requests and recommendations made in respect of Safeguarding.
YOUR DATA
How We Use Your Data:
The personal information you provide is passed to the Chief Executive of Skills Funding (“the Agency”) and, when needed, the
Young People’s Learning Agency for England (“the YPLA”) to meet legal duties under the Apprenticeships, Skills, Children and
Learning Act 2009, and for the Agency’s Learning Records Service (LRS) to create and maintain a unique learner number (ULN).
The information you provide may be shared with other partner organisations for purposes relating to education or training.
Further information about use of and access to your personal data, and details of partner organisations are available at:
http://skillsfundingagency.bis.gov.uk/privacy.htm
http://www.ypla.gov.uk/privacy.htm
http://www.learningrecordsservice.org.uk/documentlibrary/documents/Code+of+Practice+for+Sharing+of+Personal+Information.ht
m
Declaration
Learner ‘I confirm that all the information on this form is correct. I understand that if I have declared false information the provider may take
action against me to reclaim the tuition fees and any support costs provided.’
I agree to be enrolled at the Centre and wish to register on the qualification detailed on the first page.
Date: D D M M Y Y Signature:
Apprenticeships (created 13/05/16)
6
Provider Commitment
Our Commitment to you:






You will be supported, mentored and trained by qualified Staff in a safe environment (where your tutor is not yet qualified their
work will be counter-signed by a qualified tutor)
You will have access to specific information, advice and guidance about our services to ensure you are embarking on the
right programme, course and career.
You will be treated with understanding and respect.
We will seek your opinions on the quality of our programme and training and the environment in which you learn and achieve.
We will respond quickly to your comments and suggestions.
We will provide you with an information and Advisory service (IAG), right from the first enquiry through to your exit interview
(where your circumstances require more depth guidance than we can provide you will be referred to an alternative IAG
provider).
Employer Commitment
I AGREE:




















To allow the learner paid time during normal working hours to undertake qualifications, training and examinations as specified
in this/her Individual Learning Plan (ILP).
To make sure the learner has in place a written contract of employment that as a minimum includes hours of work, pay,
conditions, holidays, notice requirements, grievance/absence/ disciplinary procedures.
To pay the learner in line with the requirements of the National Minimum Wage legislation for apprentices that applies to all
apprentices aged under 19 and apprentices aged 19 or over in the first year of their Apprenticeship.
To provide, (if asked) required evidence for the Skills Funding Agency (SFA)/Funders. For example, contracts of employment
/evidence of wage payments.
To provide as far as possible, facilities, experience and training in the workplace that will help the learner to achieve his/her
learning programme as agreed with you in the ILP and to notify us promptly if you become aware of any reasons or factors
that may impact on the learner’s ability to achieve his/her qualification requirements; including sickness or disciplinary
procedures which exceeds 10 days.
To allow Assessor/Tutors access to the learner as and when required with prior agreed arrangements.
To an active involvement in reviewing the learners’ progress (including attending progress reviews every 8 -10
weeks and assessment visit feedback after every visit from the assessor) and setting targets for their progression.
To ensure the work based training undertaken will follow the programme agreed in advance with the employer and
training provider as confirmed in the learner ILP. To ensure all learners under 18 are supervised by a competent
professional at all times who is not responsible for more than 8 learners at any one time.
To ensure all learners are encouraged and allowed sufficient time to complete all components of the qualification to
demonstrate the competence to assessors, internal/ external verifiers, funding organisations and Ofsted.
To allow us to undertake Health and Safety checks of your premises as and when required and to work with us to rectify any
concerns or problems identified.
To take all necessary steps for securing the health, safety and welfare of the learner as required under relevant legislation.
To have valid Employers and Public Liability Insurance in place. To notify the provider of any changes in the insurance that
may have a material effect on the programme of training.
To notify the provider of any accidents of any learner whilst in the employer premises within 24 hours.
To make the learner aware of any risks associated with their job role and provide sufficient training and support.
Provide a healthy and safe working environment to include information, support and training to allow the learner to carry out
their job role safely.
Provide a non-discriminatory working environment, free from bullying, harassment and threat.
To respect the learners’ beliefs, values and culture.
To notify us as soon as possible if the learner has either left your employment or is working their notice period.
From time to time you may be asked to speak to/allow access to external organisations such as Ofsted or the Skills Funding
Agency. These organisations look at the quality of delivery and financial aspects of the WBL programmes we deliver.
To allow us to share your details with auditing/contracting bodies such as the (SFA) and Ofsted.
To contribute to learner and employer feedback and consultation to help us improve our services.
I agree to abide by and accept my responsibilities with regard to all requests and recommendations made in respect of
Safeguarding the individual learner.
Employer
Declaration
Employer
I confirm that, to the best of my knowledge, the information on this form is correct.
I confirm that the learner has a current contract of employment working for the Company (This
section may be completed by a representative of the employer e.g. Foreman, Site Supervisor,
Project Manager Etc.)
I confirm that I have read and understood the “Employer
Commitment” statement on page 8 of this document.
Employer Signature
Apprenticeships (created 13/05/16)
Date
7
D
D
M
M
Y
Y
Learner Risk Assessment (in conjunction with Employer Workplace Assessment)
Management of learner’s health & safety
Evidence
Has the employer assessed the risks to the learner taking into
account their age, inexperience, immaturity and lack of awareness
of risks?
Have the assessments taken into account any other special needs
or circumstances including disability and/or medical/ health
condition?


Yes
No




Yes
No


Yes
No
Yes
No
Does the employer provide, free of charge, any necessary personal
protective equipment and clothing (as determined in the risk
assessment) and ensure its proper effective use?




Are there any specific H&S issues which the Assessor needs to be
aware of / trained on?


Yes
No
Detail any necessary prohibitions and restrictions identified by the
risk assessments that apply to the learner
Does the employer provide competent supervision for the learner
and do they have a designated overall responsibility for them?
(where necessary suitability checks may be required for reasons of
child protection)
Does the employer provide an induction and ongoing information,
instruction and training to the learner?
Yes
No
Yes
No
Action Plan
Action Required
Who
Completed
(signed by provider)
Target Date
Section 6: Declaration
Learner
I have discussed with my Training Provider and Employer (where appropriate) the content and
details of this plan and I am satisfied with the arrangements set out within. I confirm this plan
was prepared and completed during my induction period.
Learner Declaration
IAG: This Individual Learning Plan has been discussed, agreed and is based on the
Information, Advice and Guidance given to me by my training provider.
‘I confirm that all the information on this form is correct. I understand that if I have declared false
information the provider may take action against me to reclaim the tuition fees and any support
costs provided. I fully agree with the “Learner Commitment” statement on page 5 of this
document.
I agree to be enrolled with the provider and wish to register on the qualification detailed
on the first page.
Learner Signature
Provider signature
Apprenticeships (created 13/05/16)
Date
Date
8
D
D
D
D
M
M
M
M
Y
Y
Y
Y
Learner’s names
The Provider
should X this box if
this is a change
notification
Learner reference number
Box
A
Individualised Learner Record 2015/16 – Programme Aims ONLY (Funded or Non-funded)
Learning Start Information
Aim type
Learning aim reference
Funding
model (code 45
Z
P
R
O
G
0
0
1
Learning start
date
/
/ 20
Learning planned
end date
/
/ 20
Programme type (Code 2,3,20,21 only)
or 99 only)
Programme entry
route
Delivery location postcode
Learning End Information
Learning actual end date
/
/ 20
Achievement date
/
/ 20
Required if Outcome is achieved
Completion status
Withdrawal reason
Outcome
Required is Completion status = 3
Actual progression route
Provider’s Signature
/
Date
/ 20
Programme Aim
Individualised Learner Record 2015/16 – Apprenticeship Component Aims ONLY (Funded and Non-funded)
Learning Start Information
Aim type
Learning aim reference
Funding
model
Programme
type (Code 2, 3,
20,21 only)
Learning start
date
Learning Planned
end date
Main delivery
method
Delivery location
postcode
Subcontracted or
partnership UKPRN
Planned credit value †
Only required for learning aims in QCF unit trials
Learning End Information
Learning actual
end date
/
/ 20
Completion
status
Withdrawal reason
Provider’s Signature
Apprenticeships (created 13/05/16)
Date
9
Achievement date
Outcome
Required is Completion status = 3
/
Required if Outcome is achieved
/ 20
/
NVQ/QCF
/ 20
Individualised Learner Record 2015/16 – Apprenticeship Component Aims ONLY (Funded and Non-funded)
Learning Start Information
Learning start
Aim type
Learning aim reference
date
Programme
Funding
Main delivery
type (Code 2, 3,
model
method
Learning Planned
end date
20,21 only)
Delivery location
postcode
Subcontracted or
partnership UKPRN
Planned credit value †
Only required for learning aims in QCF unit trials
Learning End Information
Learning actual
end date
/
/ 20
Completion
status
Withdrawal reason
Provider’s Signature
Achievement date
Outcome
Required is Completion status = 3
/
Date
Required if Outcome is achieved
/ 20
/
/ 20
FS English
Individualised Learner Record 2015/16 – Apprenticeship Component Aims ONLY (Funded and Non-funded)
Learning Start Information
Aim type
Learning aim reference
Funding
model
Programme
type (Code 2, 3,
20,21 only)
Learning start
date
Learning Planned
end date
Main delivery
method
Delivery location
postcode
Subcontracted or
partnership UKPRN
Planned credit value †
Only required for learning aims in QCF unit trials
Learning End Information
Learning actual
end date
/
/ 20
Completion
status
Withdrawal reason
Provider’s Signature
Apprenticeships (created 13/05/16)
Date
10
Achievement date
Outcome
Required is Completion status = 3
/
Required if Outcome is achieved
/ 20
/
FS Maths
/ 20
Individualised Learner Record 2015/16 – Apprenticeship Component Aims ONLY (Funded and Non-funded)
Learning Start Information
Aim type
Learning aim reference
Funding
model
Programme
type (Code 2, 3,
20,21 only)
Learning start
date
Learning Planned
end date
Main delivery
method
Delivery location
postcode
Subcontracted or
partnership UKPRN
Planned credit value †
Only required for learning aims in QCF unit trials
Learning End Information
Learning actual
end date
/
/ 20
Completion
status
Withdrawal reason
Provider’s Signature
Apprenticeships (created 13/05/16)
Date
11
Achievement date
Outcome
Required is Completion status = 3
/
Required if Outcome is achieved
/ 20
/
FS ICT/BTEC
/ 20